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Tracking development assistance for health and for COVID-19: a review of development assistance, government, out-of-pocket, and other private spending on health for 204 countries and territories, 1990–2050

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Title: Tracking development assistance for health and for COVID-19: a review of development assistance, government, out-of-pocket, and other private spending on health for 204 countries and territories, 1990–2050
Authors: Micah, AE
Cogswell, IE
Cunningham, B
Ezoe, S
Harle, AC
Maddison, ER
McCracken, D
Nomura, S
Simpson, KE
Stutzman, HN
Tsakalos, G
Javaheri, T
Jayapal, SK
Jayawardena, R
Jazayeri, SB
Jha, RP
Jonas, JB
Joo, T
Joukar, F
Jürisson, M
Abolhassani, H
Chattu, VK
Kaambwa, B
Kalhor, R
Kanchan, T
Kandel, H
Karami Matin, B
Karimi, SE
Kassahun, G
Kayode, GA
Kazemi Karyani, A
Keikavoosi-Arani, L
Chen, S
Abrigo, MRM
Khader, YS
Khajuria, H
Khalilov, R
Khammarnia, M
Khan, J
Khubchandani, J
Kianipour, N
Kim, GR
Kim, YJ
Cicero, AFG
Kisa, A
Adhikari, TB
Kisa, S
Kohler, S
Kosen, S
Koteeswaran, R
Koulmane Laxminarayana, SL
Koyanagi, A
Krishan, K
Kumar, GA
Dadras, O
Kusuma, D
Lamnisos, D
Afzal, S
Lansingh, VC
Larsson, AO
Lasrado, S
Le, LKD
Lee, SWH
Lee, YY
Lim, SS
Dahlawi, SMA
Lobo, SW
Lozano, R
Magdy Abd El Razek, H
Ahinkorah, BO
Magdy Abd El Razek, M
Mahdavi, MM
Majeed, A
Makki, A
Maleki, A
Malekzadeh, R
Dai, X
Manda, AL
Mansour-Ghanaei, F
Mansournia, MA
Marrugo Arnedo, CA
Ahmadi, S
Martinez-Valle, A
Masoumi, SZ
Maude, RJ
McKee, M
Medina-Solís, CE
Dalal, K
Menezes, RG
Meretoja, A
Meretoja, TJ
Mesregah, MK
Mestrovic, T
Ahmed, H
Milevska Kostova, N
Miller, TR
Mini, GK
Mirica, A
Dandona, L
Mirrakhimov, EM
Mohajer, B
Mohamed, TA
Mohammadi, M
Mohammadian-Hafshejani, A
Mohammed, S
Ahmed, MB
Moitra, M
Mokdad, AH
Molokhia, M
Dandona, R
Moni, MA
Moradi, Y
Morze, J
Mousavi, SM
Mpundu-Kaambwa, C
Muriithi, MK
Muthupandian, S
Ahmed Rashid, T
Nagarajan, AJ
Naimzada, MD
Davitoiu, DV
Nangia, V
Naqvi, AA
Narayana, AI
Nascimento, BR
Naveed, M
Nayak, BP
Nazari, J
Ndejjo, R
Ajami, M
Negoi, I
Wallace, LE
Neupane Kandel, S
Nguyen, TH
Nonvignon, J
Noubiap, JJ
Nwatah, VE
Oancea, B
Ojelabi, FAO
Olagunju, AT
Olakunde, BO
Aji, B
De Neve, J-W
Olgiati, S
Olusanya, JO
Onwujekwe, OE
Otoiu, A
Otstavnov, N
Otstavnov, SS
Owolabi, MO
Padubidri, JR
Palladino, R
Panda-Jonas, S
De Sá-Junior, AR
Akalu, Y
Park, E-C
Pashazadeh Kan, F
Pawar, S
Pazoki Toroudi, H
Pereira, DM
Perianayagam, A
Pesudovs, K
Piccinelli, C
Postma, MJ
Denova-Gutiérrez, E
Prada, SI
Akunna, CJ
Rabiee, M
Rabiee, N
Rahim, F
Rahimi-Movaghar, V
Rahman, MHU
Rahman, M
Rahmani, AM
Ram, U
Dhamnetiya, D
Ranabhat, CL
Ranasinghe, P
Al Hamad, H
Rao, CR
Rathi, P
Rawaf, DL
Rawaf, S
Rawal, L
Rawassizadeh, R
Reiner Jr, RC
Dharmaratne, SD
Renzaho, AMN
Reshmi, B
Riaz, MA
Alam, K
Ripon, RK
Saad, AM
Sahraian, MA
Sahu, M
Salama, JS
Salehi, S
Doshmangir, L
Samy, AM
Sanabria, J
Sanmarchi, F
Santos, JV
Alanezi, FM
Santric-Milicevic, MM
Sathian, B
Savic, M
Saxena, D
Sayyah, M
Dube, J
Schwendicke, F
Senthilkumaran, S
Sepanlou, SG
Seylani, A
Shahabi, S
Alanzi, TM
Shaikh, MA
Sheikh, A
Shetty, A
Shetty, PH
Ehsani-Chimeh, E
Shibuya, K
Shrime, MG
Shuja, KH
Singh, JA
Skryabin, VY
Skryabina, AA
Alemayehu, Y
Soltani, S
Soofi, M
Spurlock, EE
El Sayed Zaki, M
Stefan, SC
Szerencsés, V
Szócska, M
Tabarés-Seisdedos, R
Taddele, BW
Tefera, YG
Thavamani, A
Alhassan, RK
Tobe-Gai, R
Topor-Madry, R
El Tantawi, M
Tovani-Palone, MR
Tran, BX
Tudor Car, L
Ullah, A
Ullah, S
Umar, N
Undurraga, EA
Valdez, PR
Alinia, C
Vasankari, TJ
Zhao, Y
Villafañe, JH
Violante, FS
Vlassov, V
Vo, B
Vollmer, S
Vos, T
Vu, GT
Vu, LG
Wamai, RG
Aljunid, SM
Eskandarieh, S
Werdecker, A
Woldekidan, MA
Wubishet, BL
Xu, G
Yaya, S
Yazdi-Feyzabadi, V
Yiğit, V
Yip, P
Yirdaw, BW
Yonemoto, N
Farzadfar, F
Almustanyir, SA
Younis, MZ
Yu, C
Yunusa, I
Zahirian Moghadam, T
Zandian, H
Zastrozhin, MS
Zastrozhina, A
Zhang, Z-J
Ziapour, A
Ferede, TY
Zuniga, YMH
Alvis-Guzman, N
Hay, SI
Murray, CJL
Dieleman, JL
Alvis-Zakzuk, NJ
Amini, S
Amini-Rarani, M
Amu, H
Ancuceanu, R
Fischer, F
Andrei, CL
Andrei, T
Angell, B
Anjomshoa, M
Antonio, CAT
Antony, CM
Aqeel, M
Arabloo, J
Arab-Zozani, M
Aripov, T
Foigt, NA
Arrigo, A
Ashraf, T
Atnafu, DD
Ausloos, M
Avila-Burgos, L
Awan, AT
Ayano, G
Ayanore, MA
Azari, S
Azhar, GS
Freitas, A
Babalola, TK
Bahrami, MA
Baig, AA
Banach, M
Barati, N
Bärnighausen, TW
Barrow, A
Basu, S
Baune, BT
Bayati, M
Friedman, SD
Benzian, H
Berman, AE
Bhagavathula, AS
Bhardwaj, N
Bhardwaj, P
Bhaskar, S
Bibi, S
Bijani, A
Bodolica, V
Bragazzi, NL
Fukumoto, T
Braithwaite, D
Breitborde, NJK
Breusov, AV
Briko, NI
Busse, R
Cahuana-Hurtado, L
Callander, EJ
Cámera, LA
Castañeda-Orjuela, CA
Catalá-López, F
Fullman, N
Charan, J
Chatterjee, S
Chattu, SK
Gaal, PA
Zende, RR
Gad, MM
Garcia-Gordillo, MA
Garg, T
Ghafourifard, M
Ghashghaee, A
Gholamian, A
Gholamrezanezhad, A
Ghozali, G
Gilani, SA
Glăvan, I-R
Abbafati, C
Glushkova, EV
Goharinezhad, S
Golechha, M
Goli, S
Guha, A
Gupta, VB
Gupta, VK
Haakenstad, A
Haider, MR
Hailu, A
Abdelmasseh, M
Hamidi, S
Hanif, A
Harapan, H
Hartono, RK
Hasaballah, AI
Hassan, S
Hassanein, MH
Hayat, K
Hegazy, MI
Heidari, G
Abedi, A
Hendrie, D
Heredia-Pi, I
Herteliu, C
Hezam, K
Holla, R
Hossain, SJ
Hosseinzadeh, M
Hostiuc, S
Huda, TM
Hwang, B-F
Abegaz, KH
Iavicoli, I
Idrisov, B
Ilesanmi, OS
Irvani, SSN
Islam, SMS
Ismail, NE
Isola, G
Jahani, MA
Jahanmehr, N
Jakovljevic, M
Abhilash, ES
Janodia, MD
Item Type: Journal Article
Abstract: Background The rapid spread of COVID-19 renewed the focus on how health systems across the globe are financed, especially during public health emergencies. Development assistance is an important source of health financing in many low-income countries, yet little is known about how much of this funding was disbursed for COVID-19. We aimed to put development assistance for health for COVID-19 in the context of broader trends in global health financing, and to estimate total health spending from 1995 to 2050 and development assistance for COVID-19 in 2020. Methods We estimated domestic health spending and development assistance for health to generate total health-sector spending estimates for 204 countries and territories. We leveraged data from the WHO Global Health Expenditure Database to produce estimates of domestic health spending. To generate estimates for development assistance for health, we relied on project-level disbursement data from the major international development agencies' online databases and annual financial statements and reports for information on income sources. To adjust our estimates for 2020 to include disbursements related to COVID-19, we extracted project data on commitments and disbursements from a broader set of databases (because not all of the data sources used to estimate the historical series extend to 2020), including the UN Office of Humanitarian Assistance Financial Tracking Service and the International Aid Transparency Initiative. We reported all the historic and future spending estimates in inflation-adjusted 2020 US$, 2020 US$ per capita, purchasing-power parity-adjusted US$ per capita, and as a proportion of gross domestic product. We used various models to generate future health spending to 2050. Findings In 2019, health spending globally reached $8·8 trillion (95% uncertainty interval [UI] 8·7–8·8) or $1132 (1119–1143) per person. Spending on health varied within and across income groups and geographical regions. Of this total, $40·4 billion (0·5%, 95% UI 0·5–0·5) was development assistance for health provided to low-income and middle-income countries, which made up 24·6% (UI 24·0–25·1) of total spending in low-income countries. We estimate that $54·8 billion in development assistance for health was disbursed in 2020. Of this, $13·7 billion was targeted toward the COVID-19 health response. $12·3 billion was newly committed and $1·4 billion was repurposed from existing health projects. $3·1 billion (22·4%) of the funds focused on country-level coordination and $2·4 billion (17·9%) was for supply chain and logistics. Only $714·4 million (7·7%) of COVID-19 development assistance for health went to Latin America, despite this region reporting 34·3% of total recorded COVID-19 deaths in low-income or middle-income countries in 2020. Spending on health is expected to rise to $1519 (1448–1591) per person in 2050, although spending across countries is expected to remain varied. Interpretation Global health spending is expected to continue to grow, but remain unequally distributed between countries. We estimate that development organisations substantially increased the amount of development assistance for health provided in 2020. Continued efforts are needed to raise sufficient resources to mitigate the pandemic for the most vulnerable, and to help curtail the pandemic for all. Funding Bill & Melinda Gates Foundation.
Issue Date: 9-Oct-2021
Date of Acceptance: 1-Sep-2021
URI: http://hdl.handle.net/10044/1/91816
DOI: 10.1016/s0140-6736(21)01258-7
ISSN: 0140-6736
Publisher: Elsevier BV
Start Page: 1317
End Page: 1343
Journal / Book Title: The Lancet
Volume: 398
Issue: 10308
Copyright Statement: © 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license
Keywords: Science & Technology
Life Sciences & Biomedicine
Medicine, General & Internal
General & Internal Medicine
INCOME
COVID-19
Developing Countries
Economic Development
Financing, Government
Global Health
Government Programs
Gross Domestic Product
Health Expenditures
Healthcare Financing
Humans
International Agencies
International Cooperation
Global Burden of Disease 2020 Health Financing Collaborator Network
Humans
Government Programs
International Cooperation
Developing Countries
Health Expenditures
Financing, Government
International Agencies
Economic Development
Gross Domestic Product
Healthcare Financing
Global Health
COVID-19
General & Internal Medicine
11 Medical and Health Sciences
Publication Status: Published
Open Access location: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)01258-7/fulltext#
Online Publication Date: 2021-09-22
Appears in Collections:Imperial College Business School
Faculty of Medicine
Imperial College London COVID-19
School of Public Health



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