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Cited by 165Global Health Care IssuesInternational Development and AidHealthcare Systems and Reforms

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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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Micah, Angela E, Cogswell, Ian E, Cunningham, Brandon, Ezoe, Satoshi, Harle, Anton C, Maddison, Emilie R, McCracken, Darrah, Nomura, Shuhei, Simpson, Kyle E, Stutzman, Hayley N, Tsakalos, Golsum, Wallace, Lindsey E, Zhao, Yingxi, Zende, Rahul R, Abbafati, Cristiana, Abdelmasseh, Michael, Abedi, Aidin, Abegaz, Kedir Hussein, Abhilash, E S, Abolhassani, Hassan, Abrigo, Michael R M, Adhikari, Tara Ballav, Afzal, Saira, Ahinkorah, Bright Opoku, Ahmadi, Sepideh, Ahmed, Haroon, Ahmed, Muktar Beshir, Ahmed Rashid, Tarik, Ajami, Marjan, Aji, Budi, Akalu, Yonas, Akunna, Chisom Joyqueenet, Al Hamad, Hanadi, Alam, Khurshid, Alanezi, Fahad Mashhour, Alanzi, Turki M, Alemayehu, Yosef, Alhassan, Robert Kaba, Alinia, Cyrus, Aljunid, Syed Mohamed, Almustanyir, Sami Almustanyir, Alvis-Guzman, Nelson, Alvis-Zakzuk, Nelson J, Amini, Saeed, Amini-Rarani, Mostafa, Amu, Hubert, Ancuceanu, Robert, Andrei, Catalina Liliana, Andrei, Tudorel, Angell, Blake, Anjomshoa, Mina, Antonio, Carl Abelardo T, Antony, Catherine M, Aqeel, Muhammad, Arabloo, Jalal, Arab-Zozani, Morteza, Aripov, Timur, Arrigo, Alessandro, Ashraf, Tahira, Atnafu, Desta Debalkie, Ausloos, Marcel, Avila-Burgos, Leticia, Awan, Asma Tahir, Ayano, Getinet, Ayanore, Martin Amogre, Azari, Samad, Azhar, Gulrez Shah, Babalola, Tesleem Kayode, Bahrami, Mohammad Amin, Baig, Atif Amin, Banach, Maciej, Barati, Nastaran, Bärnighausen, Till Winfried, Barrow, Amadou, Basu, Sanjay, Baune, Bernhard T, Bayati, Mohsen, Benzian, Habib, Berman, Adam E, Bhagavathula, Akshaya Srikanth, Bhardwaj, Nikha, Bhardwaj, Pankaj, Bhaskar, Sonu, Bibi, Sadia, Bijani, Ali, Bodolica, Virginia, Bragazzi, Nicola Luigi, Braithwaite, Dejana, Breitborde, Nicholas J K, Breusov, Alexey V, Briko, Nikolay Ivanovich, Busse, Reinhard, Cahuana-Hurtado, Lucero, Callander, Emily Joy, Cámera, Luis Alberto, Castañeda-Orjuela, Carlos A, Catalá-López, Ferrán, Charan, Jaykaran, Chatterjee, Souranshu, Chattu, Soosanna Kumary, Chattu, Vijay Kumar, Chen, Simiao, Cicero, Arrigo Francesco Giuseppe, Dadras, Omid, Dahlawi, Saad M A, Dai, Xiaochen, Dalal, Koustuv, Dandona, Lalit, Dandona, Rakhi, Davitoiu, Dragos Virgil, De Neve, Jan-Walter, de Sá-Junior, Antonio Reis, Denova-Gutiérrez, Edgar, Dhamnetiya, Deepak, Dharmaratne, Samath Dhamminda, Doshmangir, Leila, Dube, John, Ehsani-Chimeh, Elham, El Sayed Zaki, Maysaa, El Tantawi, Maha, Eskandarieh, Sharareh, Farzadfar, Farshad, Ferede, Tomas Y, Fischer, Florian, Foigt, Nataliya A, Freitas, Alberto, Friedman, Sara D, Fukumoto, Takeshi, Fullman, Nancy, Gaal, Peter Andras, Gad, Mohamed M, Garcia-Gordillo, MA, Garg, Tushar, Ghafourifard, Mansour, Ghashghaee, Ahmad, Gholamian, Asadollah, Gholamrezanezhad, Ali, Ghozali, Ghozali, Gilani, Syed Amir, Glăvan, Ionela-Roxana, Glushkova, Ekaterina Vladimirovna, Goharinezhad, Salime, Golechha, Mahaveer, Goli, Srinivas, Guha, Avirup, Gupta, Veer Bala, Gupta, Vivek Kumar, Haakenstad, Annie, Haider, Mohammad Rifat, Hailu, Alemayehu, Hamidi, Samer, Hanif, Asif, Harapan, Harapan, Hartono, Risky Kusuma, Hasaballah, Ahmed I, Hassan, Shoaib, Hassanein, Mohamed H, Hayat, Khezar, Hegazy, Mohamed I, Heidari, Golnaz, Hendrie, Delia, Heredia-Pi, Ileana, Herteliu, Claudiu, Hezam, Kamal, Holla, Ramesh, Hossain, Sheikh Jamal, Hosseinzadeh, Mehdi, Hostiuc, Sorin, Huda, Tanvir M, Hwang, Bing-Fang, Iavicoli, Ivo, Idrisov, Bulat, Ilesanmi, Olayinka Stephen, Irvani, Seyed Sina Naghibi, Islam, Sheikh Mohammed Shariful, Ismail, Nahlah Elkudssiah, Isola, Gaetano, Jahani, Mohammad Ali, Jahanmehr, Nader, Jakovljevic, Mihajlo, Janodia, Manthan Dilipkumar, Javaheri, Tahereh, Jayapal, Sathish Kumar, Jayawardena, Ranil, Jazayeri, Seyed Behzad, Jha, Ravi Prakash, Jonas, Jost B, Joo, Tamas, Joukar, Farahnaz, Jürisson, Mikk, Kaambwa, Billingsley, Kalhor, Rohollah, Kanchan, Tanuj, Kandel, Himal, Karami Matin, Behzad, Karimi, Salah Eddin, Kassahun, Getinet, Kayode, Gbenga A, Kazemi Karyani, Ali, Keikavoosi-Arani, Leila, Khader, Yousef Saleh, Khajuria, Himanshu, Khalilov, Rovshan, Khammarnia, Mohammad, Khan, Junaid, Khubchandani, Jagdish, Kianipour, Neda, Kim, Gyu Ri, Kim, Yun Jin, Kisa, Adnan, Kisa, Sezer, Kohler, Stefan, Kosen, Soewarta, Koteeswaran, Rajasekaran, Koulmane Laxminarayana, Sindhura Lakshmi, Koyanagi, Ai, Krishan, Kewal, Kumar, G Anil, Kusuma, Dian, Lamnisos, Demetris, Lansingh, Van Charles, Larsson, Anders O, Lasrado, Savita, Le, Long Khanh Dao, Lee, Shaun Wen Huey, Lee, Yeong Yeh, Lim, Stephen S, Lobo, Stany W, Lozano, Rafael, Magdy Abd El Razek, Hassan, Magdy Abd El Razek, Muhammed, Mahdavi, Mokhtar Mahdavi, Majeed, Azeem, Makki, Alaa, Maleki, Afshin, Malekzadeh, Reza, Manda, Ana Laura, Mansour-Ghanaei, Fariborz, Mansournia, Mohammad Ali, Marrugo Arnedo, Carlos Alberto, Martinez-Valle, Adolfo, Masoumi, Seyedeh Zahra, Maude, Richard James, McKee, Martin, Medina-Solís, Carlo Eduardo, Menezes, Ritesh G, Meretoja, Atte, Meretoja, Tuomo J, Mesregah, Mohamed Kamal, Mestrovic, Tomislav, Milevska Kostova, Neda, Miller, Ted R, Mini, GK, Mirica, Andreea, Mirrakhimov, Erkin M, Mohajer, Bahram, Mohamed, Teroj Abdulrahman, Mohammadi, Mokhtar, Mohammadian-Hafshejani, Abdollah, Mohammed, Shafiu, Moitra, Modhurima, Mokdad, Ali H, Molokhia, Mariam, Moni, Mohammad Ali, Moradi, Yousef, Morze, Jakub, Mousavi, Seyyed Meysam, Mpundu-Kaambwa, Christine, Muriithi, Moses K, Muthupandian, Saravanan, Nagarajan, Ahamarshan Jayaraman, Naimzada, Mukhammad David, Nangia, Vinay, Naqvi, Atta Abbas, Narayana, Aparna Ichalangod, Nascimento, Bruno Ramos, Naveed, Muhammad, Nayak, Biswa Prakash, Nazari, Javad, Ndejjo, Rawlance, Negoi, Ionut, Neupane Kandel, Sandhya, Nguyen, Trang Huyen, Nonvignon, Justice, Noubiap, Jean Jacques, Nwatah, Vincent Ebuka, Oancea, Bogdan, Ojelabi, Foluke Adetola Ogunyemi, Olagunju, Andrew T, Olakunde, Babayemi Oluwaseun, Olgiati, Stefano, Olusanya, Jacob Olusegun, Onwujekwe, Obinna E, Otoiu, Adrian, Otstavnov, Nikita, Otstavnov, Stanislav S, Owolabi, Mayowa O, Padubidri, Jagadish Rao, Palladino, Raffaele, Panda-Jonas, Songhomitra, Park, Eun-Cheol, Pashazadeh Kan, Fatemeh, Pawar, Shrikant, Pazoki Toroudi, Hamidreza, Pereira, David M, Perianayagam, Arokiasamy, Pesudovs, Konrad, Piccinelli, Cristiano, Postma, Maarten J, Prada, Sergio I, Rabiee, Mohammad, Rabiee, Navid, Rahim, Fakher, Rahimi-Movaghar, Vafa, Rahman, Mohammad Hifz Ur, Rahman, Mosiur, Rahmani, Amir Masoud, Ram, Usha, Ranabhat, Chhabi Lal, Ranasinghe, Priyanga, Rao, Chythra R, Rathi, Priya, Rawaf, David Laith, Rawaf, Salman, Rawal, Lal, Rawassizadeh, Reza, Reiner Jr, Robert C, Renzaho, Andre M N, Reshmi, Bhageerathy, Riaz, Mavra A, Ripon, Rezaul Karim, Saad, Anas M, Sahraian, Mohammad Ali, Sahu, Maitreyi, Salama, Joseph S, Salehi, Sana, Samy, Abdallah M, Sanabria, Juan, Sanmarchi, Francesco, Santos, João Vasco, Santric-Milicevic, Milena M, Sathian, Brijesh, Savic, Miloje, Saxena, Deepak, Sayyah, Mehdi, Schwendicke, Falk, Senthilkumaran, Subramanian, Sepanlou, Sadaf G, Seylani, Allen, Shahabi, Saeed, Shaikh, Masood Ali, Sheikh, Aziz, Shetty, Adithi, Shetty, Pavanchand H, Shibuya, Kenji, Shrime, Mark G, Shuja, Kanwar Hamza, Singh, Jasvinder A, Skryabin, Valentin Yurievich, Skryabina, Anna Aleksandrovna, Soltani, Shahin, Soofi, Moslem, Spurlock, Emma Elizabeth, Stefan, Simona Cătălina, Szerencsés, Viktória, Szócska, Miklós, Tabarés-Seisdedos, Rafael, Taddele, Biruk Wogayehu, Tefera, Yonas Getaye, Thavamani, Aravind, Tobe-Gai, Ruoyan, Topor-Madry, Roman, Tovani-Palone, Marcos Roberto, Tran, Bach Xuan, Tudor Car, Lorainne, Ullah, Anayat, Ullah, Saif, Umar, Nasir, Undurraga, Eduardo A, Valdez, Pascual R, Vasankari, Tommi Juhani, Villafañe, Jorge Hugo, Violante, Francesco S, Vlassov, Vasily, Vo, Bay, Vollmer, Sebastian, Vos, Theo, Vu, Giang Thu, Vu, Linh Gia, Wamai, Richard G, Werdecker, Andrea, Woldekidan, Mesfin Agachew, Wubishet, Befikadu Legesse, Xu, Gelin, Yaya, Sanni, Yazdi-Feyzabadi, Vahid, Yiğit, Vahit, Yip, Paul, Yirdaw, Birhanu Wubale, Yonemoto, Naohiro, Younis, Mustafa Z, Yu, Chuanhua, Yunusa, Ismaeel, Zahirian Moghadam, Telma, Zandian, Hamed, Zastrozhin, Mikhail Sergeevich, Zastrozhina, Anasthasia, Zhang, Zhi-Jiang, Ziapour, Arash, Zuniga, Yves Miel H, Hay, Simon I, Murray, Christopher J L, Dieleman, Joseph L·2021·The Lancet
DOI 10.1016/s0140-6736(21)01258-7PMC PMC8457757
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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.

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Figure 1 Development assistance for health by health focus area, 1990–2020 HSS/SWAps=health system strengthening and sector-wide approaches. *Other captures development assistance for health for which we have health focus area information but is not identified as being allocated to any of the health focus areas listed. Health assistance for which we have no health focus area information is designated as unassigned. †2019 and 2020 disbursement estimates are preliminary.
Figure 1 Development assistance for health by health focus area, 1990–2020 HSS/SWAps=health system strengthening and sector-wide approaches. *Other captures development assistance for health for which we have health focus area information but is not identified as being allocated to any of the health focus areas listed. Health assistance for which we have no health focus area information is designated as unassigned. †2019 and 2020 disbursement estimates are preliminary.CC BY · PubMed Central
Figure 2 Development assistance for health, 1990–2020 (A) Development assistance for health by source of funding. (B) Development assistance for health by channel of assistance. (C) Development assistance for other infectious disease programme areas. (D) Development assistance for health systems strengthening programmes. CEPI=Coalition for Epidemic Preparedness Innovations. GAVI=Gavi, the Vaccine Alliance. HSS/SWAps=health systems strengthening and sector-wide approaches. IBRD=International Bank for Reconstruction and Development. NGO=non-governmental organisation. PAHO=Pan American Health Organization. UNFPA=UN Population Fund. *Other captures development assistance for health for which we have source information but is not identified as being allocated to any of the health focus areas listed. Health assistance for which we have no health focus area information is designated as unassigned. †2019 and 2020 disbursement estimates are preliminary. ‡Regional development banks include the African Development Bank, the Asian Development Bank, and the Inter-American Development Bank. §Other bilateral development agencies include Austria, Belgium, Denmark, Finland, Greece, Ireland, Italy, Luxembourg, the Netherlands, New Zealand, Norway, South Korea, Spain, Sweden, Switzerland, the United Arab Emirates, the European Commission, and the European Economic Area.
Figure 2 Development assistance for health, 1990–2020 (A) Development assistance for health by source of funding. (B) Development assistance for health by channel of assistance. (C) Development assistance for other infectious disease programme areas. (D) Development assistance for health systems strengthening programmes. CEPI=Coalition for Epidemic Preparedness Innovations. GAVI=Gavi, the Vaccine Alliance. HSS/SWAps=health systems strengthening and sector-wide approaches. IBRD=International Bank for Reconstruction and Development. NGO=non-governmental organisation. PAHO=Pan American Health Organization. UNFPA=UN Population Fund. *Other captures development assistance for health for which we have source information but is not identified as being allocated to any of the health focus areas listed. Health assistance for which we have no health focus area information is designated as unassigned. †2019 and 2020 disbursement estimates are preliminary. ‡Regional development banks include the African Development Bank, the Asian Development Bank, and the Inter-American Development Bank. §Other bilateral development agencies include Austria, Belgium, Denmark, Finland, Greece, Ireland, Italy, Luxembourg, the Netherlands, New Zealand, Norway, South Korea, Spain, Sweden, Switzerland, the United Arab Emirates, the European Commission, and the European Economic Area.CC BY · PubMed Central
Figure 3 Distribution of development assistance for health for COVID-19 by programme area, recipient region, and income group, 2020 (A) Flow of development assistance for health disbursements from source to channel to programme area for COVID-19. Data are in million (m) or billion (b) 2020 US$. (B) Percentage of disbursed development assistance for health for COVID (excluding global initiatives) and percentage of total deaths from COVID-19 by GBD super-region. (C) Percentage of disbursed development assistance for health for COVID-19 (excluding global initiatives) and percentage of total deaths from COVID-19 by World Bank income group. The COVID-19 burden is represented by the percentage of total COVID-19 deaths in 2020 for lower-middle-income countries only, as high-income countries to not receive development assistance. CEPI=Coalition for Epidemic Preparedness Innovations. DAC=Development Assistance Committee. GAVI=Gavi, the Vaccine Alliance. GBD=Global Burden of Diseases, Injuries, and Risk Factors Study HSS/SWAps=health systems strengthening and sector-wide approaches. IBRD=International Bank for Reconstruction and Development. NGO=non-governmental organisation. PAHO=Pan American Health Organization. UNFPA=UN Population Fund. *Other non-DAC governments include Afghanistan, Angola, Argentina, Azerbaijan, Bangladesh, Bhutan, Brazil, Brunei, Bulgaria, Côte d'Ivoire, Cameroon, Central African Republic, Chad, China, Colombia, Croatia, Democratic Republic of the Congo, Egypt, Estonia, Ethiopia, Gabon, Guinea, India, Indonesia, Iran, Iraq, Jamaica, Jordan, Kenya, Kuwait, Latvia, Lebanon, Libya, Lithuania, Madagascar, Malaysia, Malta, Monaco, Myanmar, Nigeria, Oman, Pakistan, Palestine, Peru, Qatar, Romania, Russia, São Tomé and Príncipe, Saudi Arabia, Serbia, Singapore, South Africa, South Sudan, Sudan, Syria, Taiwan (province of China), Thailand, Togo, Turkey, Uganda, Ukraine, United Arab Emirates, Yemen, and Zimbabwe. †Other DAC governments include Australia, Austria, Belgium, Czechia, Denmark, Finland, Greece, Hungary, Iceland, Ireland, Italy, Luxembourg, the Netherlands, New Zealand, Norway, Poland, Portugal, Slovakia, Slovenia, South Korea, Spain, Sweden, and Switzerland. ‡Development banks include the African Development Bank, the Asian Development Bank, and the Inter-American Development Bank. UN agencies include PAHO, UNAIDS, UNFPA, UNICEF, and Unitaid. §Country-level coordination includes planning, monitoring, and evaluations; risk communication and community engagement; and travel restrictions.
Figure 3 Distribution of development assistance for health for COVID-19 by programme area, recipient region, and income group, 2020 (A) Flow of development assistance for health disbursements from source to channel to programme area for COVID-19. Data are in million (m) or billion (b) 2020 US$. (B) Percentage of disbursed development assistance for health for COVID (excluding global initiatives) and percentage of total deaths from COVID-19 by GBD super-region. (C) Percentage of disbursed development assistance for health for COVID-19 (excluding global initiatives) and percentage of total deaths from COVID-19 by World Bank income group. The COVID-19 burden is represented by the percentage of total COVID-19 deaths in 2020 for lower-middle-income countries only, as high-income countries to not receive development assistance. CEPI=Coalition for Epidemic Preparedness Innovations. DAC=Development Assistance Committee. GAVI=Gavi, the Vaccine Alliance. GBD=Global Burden of Diseases, Injuries, and Risk Factors Study HSS/SWAps=health systems strengthening and sector-wide approaches. IBRD=International Bank for Reconstruction and Development. NGO=non-governmental organisation. PAHO=Pan American Health Organization. UNFPA=UN Population Fund. *Other non-DAC governments include Afghanistan, Angola, Argentina, Azerbaijan, Bangladesh, Bhutan, Brazil, Brunei, Bulgaria, Côte d'Ivoire, Cameroon, Central African Republic, Chad, China, Colombia, Croatia, Democratic Republic of the Congo, Egypt, Estonia, Ethiopia, Gabon, Guinea, India, Indonesia, Iran, Iraq, Jamaica, Jordan, Kenya, Kuwait, Latvia, Lebanon, Libya, Lithuania, Madagascar, Malaysia, Malta, Monaco, Myanmar, Nigeria, Oman, Pakistan, Palestine, Peru, Qatar, Romania, Russia, São Tomé and Príncipe, Saudi Arabia, Serbia, Singapore, South Africa, South Sudan, Sudan, Syria, Taiwan (province of China), Thailand, Togo, Turkey, Uganda, Ukraine, United Arab Emirates, Yemen, and Zimbabwe. †Other DAC governments include Australia, Austria, Belgium, Czechia, Denmark, Finland, Greece, Hungary, Iceland, Ireland, Italy, Luxembourg, the Netherlands, New Zealand, Norway, Poland, Portugal, Slovakia, Slovenia, South Korea, Spain, Sweden, and Switzerland. ‡Development banks include the African Development Bank, the Asian Development Bank, and the Inter-American Development Bank. UN agencies include PAHO, UNAIDS, UNFPA, UNICEF, and Unitaid. §Country-level coordination includes planning, monitoring, and evaluations; risk communication and community engagement; and travel restrictions.CC BY · PubMed Central
Figure 4 Type of health assistance provided towards the COVID-19 pandemic, 2020 This figure shows the amount of global development assistance for health for the COVID-19 pandemic that was repurposed versus new spending. Overall, 90·1% of global development assistance for health was new money, and 9·9% was repurposed money. ADB=Asian Development Bank. AfDB=African Development Bank. CEPI=Coalition for Epidemic Preparedness Innovations. GAVI=Gavi, the Vaccine Alliance. Global Fund=The Global Fund to Fight AIDS, Tuberculosis and Malaria. IDB=Inter-American Development Bank. NGO=Non-governmental organisation. PAHO=Pan American Health Organization. UNFPA=UN Population Fund.
Figure 4 Type of health assistance provided towards the COVID-19 pandemic, 2020 This figure shows the amount of global development assistance for health for the COVID-19 pandemic that was repurposed versus new spending. Overall, 90·1% of global development assistance for health was new money, and 9·9% was repurposed money. ADB=Asian Development Bank. AfDB=African Development Bank. CEPI=Coalition for Epidemic Preparedness Innovations. GAVI=Gavi, the Vaccine Alliance. Global Fund=The Global Fund to Fight AIDS, Tuberculosis and Malaria. IDB=Inter-American Development Bank. NGO=Non-governmental organisation. PAHO=Pan American Health Organization. UNFPA=UN Population Fund.CC BY · PubMed Central
Figure 5 Distribution of total health spending per capita in 2019 and 2050 by income group (A) 2019. (B) 2050. Estimates are reported in 2020 US$. The x-axes are presented in a natural logarithmic scale. Vertical lines represent the mean for each distribution. The World Bank income classification does not include Cook Islands, Niue, and Tokelau. The Cook Islands and Niue were assigned to the high-income group, and Tokelau was assigned to the upper-middle-income group.
Figure 5 Distribution of total health spending per capita in 2019 and 2050 by income group (A) 2019. (B) 2050. Estimates are reported in 2020 US$. The x-axes are presented in a natural logarithmic scale. Vertical lines represent the mean for each distribution. The World Bank income classification does not include Cook Islands, Niue, and Tokelau. The Cook Islands and Niue were assigned to the high-income group, and Tokelau was assigned to the upper-middle-income group.CC BY · PubMed Central

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Micah, A. E., Cogswell, I. E., Cunningham, B., Ezoe, S., Harle, A. C., Maddison, E. R., McCracken, D., Nomura, S., Simpson, K. E., Stutzman, H. N., Tsakalos, G., Wallace, L. E., Zhao, Y., Zende, R. R., Abbafati, C., Abdelmasseh, M., Abedi, A., Abegaz, K. H., Abhilash, E. S., Abolhassani, H., Abrigo, M. R. M., Adhikari, T. B., Afzal, S., Ahinkorah, B. O., Ahmadi, S., Ahmed, H., Ahmed, M. B., Ahmed Rashid, T., Ajami, M., Aji, B., Akalu, Y., Akunna, C. J., Al Hamad, H., Alam, K., Alanezi, F. M., Alanzi, T. M., Alemayehu, Y., Alhassan, R. K., Alinia, C., Aljunid, S. M., Almustanyir, S. A., Alvis-Guzman, N., Alvis-Zakzuk, N. J., Amini, S., Amini-Rarani, M., Amu, H., Ancuceanu, R., Andrei, C. L., Andrei, T., Angell, B., Anjomshoa, M., Antonio, C. A. T., Antony, C. M., Aqeel, M., Arabloo, J., Arab-Zozani, M., Aripov, T., Arrigo, A., Ashraf, T., Atnafu, D. D., Ausloos, M., Avila-Burgos, L., Awan, A. T., Ayano, G., Ayanore, M. A., Azari, S., Azhar, G. S., Babalola, T. K., Bahrami, M. A., Baig, A. A., Banach, M., Barati, N., Bärnighausen, T. W., Barrow, A., Basu, S., Baune, B. T., Bayati, M., Benzian, H., Berman, A. E., Bhagavathula, A. S., Bhardwaj, N., Bhardwaj, P., Bhaskar, S., Bibi, S., Bijani, A., Bodolica, V., Bragazzi, N. L., Braithwaite, D., Breitborde, N. J. K., Breusov, A. V., Briko, N. I., Busse, R., Cahuana-Hurtado, L., Callander, E. J., Cámera, L. A., Castañeda-Orjuela, C. A., Catalá-López, F., Charan, J., Chatterjee, S., Chattu, S. K., Chattu, V. K., Chen, S., Cicero, A. F. G., Dadras, O., Dahlawi, S. M. A., Dai, X., Dalal, K., Dandona, L., Dandona, R., Davitoiu, D. V., De Neve, J.-W., de Sá-Junior, A. R., Denova-Gutiérrez, E., Dhamnetiya, D., Dharmaratne, S. D., Doshmangir, L., Dube, J., Ehsani-Chimeh, E., El Sayed Zaki, M., El Tantawi, M., Eskandarieh, S., Farzadfar, F., Ferede, T. Y., Fischer, F., Foigt, N. A., Freitas, A., Friedman, S. D., Fukumoto, T., Fullman, N., Gaal, P. A., Gad, M. 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Affiliations
University of Washington (US)
Corresponding author
Micah, Angela E
ORCID
Venue
The Lancet
Publisher
Elsevier BV
Published
2021-10
Volume
398
Issue
10308
Pages
1317-1343
ISSN
  • 0099-5355 (ISSN-L)
  • 0140-6736
DOI
10.1016/s0140-6736(21)01258-7
PMC
PMC8457757
OpenAlex
W3199493325
Cited by
162
References
24
Citations by year
2026: 13 · 2025: 30 · 2024: 30 · 2023: 42 · 2022: 43 · 2021: 4
FWCI
6.15
Type
journal article
Language
en
Open access
Licence
Locations
  • The Lancet (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, other-oa)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DR-NTU (Nanyang Technological University) (publishedVersion, cc-by)
  • University of Groningen research database (University of Groningen / Centre for Information Technology) (publishedVersion, cc-by)
  • DSPACE System - Metalibrary (University of the Coast) (publishedVersion, cc-by-nc-nd)
  • City Research Online (City University London) (acceptedVersion)
  • Research Open (London South Bank University) (acceptedVersion, cc-by)
  • LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
  • OPUS - Open Publications of UTS Scholars (University of Technology Sydney) (submittedVersion, other-oa)
  • Minerva Access (University of Melbourne) (submittedVersion, cc-by)
  • Kocaeli Üniversitesi - AVESİS (submittedVersion)
  • UWA Profiles and Research Repository (UWA) (submittedVersion, cc-by)
  • Charles Sturt University Research Output (CRO) (submittedVersion, cc-by)
  • Murdoch University Research Portal (submittedVersion)
  • Scholar Commons (University of South Carolina) (submittedVersion, cc-by)
  • Publications (Mid Sweden University) (submittedVersion, other-oa)
  • KTH Publication Database DiVA (KTH Royal Institute of Technology) (submittedVersion, other-oa)
  • Archivio istituzionale della ricerca (Alma Mater Studiorum Università di Bologna) (submittedVersion, cc-by)
  • Own your potential (DEAKIN) (submittedVersion)
  • Figshare (submittedVersion, cc-by)
  • Työväentutkimus Vuosikirja (submittedVersion)
  • YUHSpace (Yonsei University Medical Library) (submittedVersion, cc-by-nc-nd)
  • Institutional Repositories DataBase (IRDB) (submittedVersion, cc-by)
  • IRIS Research product catalog (Sapienza University of Rome) (submittedVersion, other-oa)
  • NORA - Norwegian Open Research Archives (submittedVersion, other-oa)
  • GoeScholar The Publication Server of the Georg-August-Universität Göttingen (Georg-August-Universität Göttingen) (submittedVersion, cc-by)
  • Spiral (Imperial College London) (submittedVersion, other-oa)
  • University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion, cc-by)
Funders
Bill & Melinda Gates Foundation
Topics
  • Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Global Health Care Issues
  • Social Sciences › Development › International Development and Aid
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Healthcare Systems and Reforms
Keywords
health, COVID-19 pandemic, health care financing, out-of-pocket health expenditure, private health expenditure, public health emergencies, low-income countries, per capita health expenditure, development aid, health system resilience, health infrastructure, health system preparedness
MeSH terms
COVID-19, Developing Countries, Health Expenditures, Financing, Government, Government Programs, Humans, International Agencies, International Cooperation, Global Health, Economic Development, Gross Domestic Product, Healthcare Financing

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