Health sector spending and spending on HIV/AIDS, tuberculosis, and malaria, and development assistance for health: progress towards Sustainable Development Goal 3

Micah, Angela E and Su, Yanfang and Bachmeier, Steven D and Chapin, Abigail and Cogswell, Ian E and Crosby, Sawyer W and Cunningham, Brandon and Harle, Anton C and Maddison, Emilie R and Moitra, Modhurima and Sahu, Maitreyi and Schneider, Matthew T and Simpson, Kyle E and Stutzman, Hayley N and Tsakalos, Golsum and Zende, Rahul R and Zlavog, Bianca S and Abbafati, Cristiana and Abebo, Zeleke Hailemariam and Abolhassani, Hassan and Abrigo, Michael R M and Ahmed, Muktar Beshir and Akinyemi, Rufus Olusola and Alam, Khurshid and Ali, Saqib and Alinia, Cyrus and Alipour, Vahid and Aljunid, Syed Mohamed and Almasi, Ali and Alvis-Guzman, Nelson and Ancuceanu, Robert and Andrei, Tudorel and Andrei, Catalina Liliana and Anjomshoa, Mina and Antonio, Carl Abelardo T and Arabloo, Jalal and Arab-Zozani, Morteza and Aremu, Olatunde and Atnafu, Desta Debalkie and Ausloos, Marcel and Avila-Burgos, Leticia and Ayanore, Martin Amogre and Azari, Samad and Babalola, Tesleem Kayode and Bagherzadeh, Mojtaba and Baig, Atif Amin and Bakhtiari, Ahad and Banach, Maciej and Banerjee, Srikanta K and Bärnighausen, Till Winfried and Basu, Sanjay and Baune, Bernhard T and Bayati, Mohsen and Berman, Adam E and Bhageerathy, Reshmi and Bhardwaj, Pankaj and Bohluli, Mehdi and Busse, Reinhard and Cahuana-Hurtado, Lucero and Cámera, Luis LA Alberto and Castañeda-Orjuela, Carlos A and Catalá-López, Ferrán and Cevik, Muge and Chattu, Vijay Kumar and Dandona, Lalit and Dandona, Rakhi and Dianatinasab, Mostafa and Do, Hoa Thi and Doshmangir, Leila and El Tantawi, Maha and Eskandarieh, Sharareh and Esmaeilzadeh, Firooz and Faraj, Anwar and Farzadfar, Farshad and Fischer, Florian and Foigt, Nataliya A and Fullman, Nancy and Gad, Mohamed M and Ghafourifard, Mansour and Ghashghaee, Ahmad and Gholamian, Asadollah and Goharinezhad, Salime and Grada, Ayman and Haghparast Bidgoli, Hassan and Hamidi, Samer and Harb, Hilda L and Hasanpoor, Edris and Hay, Simon I and Hendrie, Delia and Henry, Nathaniel J and Herteliu, Claudiu and Hole, Michael K and Hosseinzadeh, Mehdi and Hostiuc, Sorin and Huda, Tanvir M and Humayun, Ayesha and Hwang, Bing-Fang and Ilesanmi, Olayinka Stephen and Iqbal, Usman and Irvani, Seyed Sina N and Islam, Sheikh Mohammed Shariful and Islam, M Mofizul and Jahani, Mohammad Ali and Jakovljevic, Mihajlo and James, Spencer L and Javaheri, Zohre and Jonas, Jost B and Joukar, Farahnaz and Jozwiak, Jacek Jerzy and Jürisson, Mikk and Kalhor, Rohollah and Karami Matin, Behzad and Karimi, Salah Eddin and Kayode, Gbenga A and Kazemi Karyani, Ali and Kinfu, Yohannes and Kisa, Adnan and Kohler, Stefan and Komaki, Hamidreza and Kosen, Soewarta and Kotlo, Anirudh and Koyanagi, Ai and Kumar, G Anil and Kusuma, Dian and Lansingh, Van C and Larsson, Anders O and Lasrado, Savita and Lee, Shaun Wen Huey and Lim, Lee-Ling and Lozano, Rafael and Magdy Abd El Razek, Hassan and Mahdavi, Mokhtar Mahdavi and Maleki, Shokofeh and Malekzadeh, Reza and Mansour-Ghanaei, Fariborz and Mansournia, Mohammad Ali and Mantovani, Lorenzo Giovanni and Martinez, Gabriel and Masoumi, Seyedeh Zahra and Massenburg, Benjamin Ballard and Menezes, Ritesh G and Mengesha, Endalkachew Worku and Meretoja, Tuomo J and Meretoja, Atte and Mestrovic, Tomislav and Milevska Kostova, Neda and Miller, Ted R and Mirica, Andreea and Mirrakhimov, Erkin M and Moghadaszadeh, Masoud and Mohajer, Bahram and Mohamadi, Efat and Mohammad Darwesh, Aso and Mohammadian-Hafshejani, Abdollah and Mohammadpourhodki, Reza and Mohammed, Shafiu and Mohebi, Farnam and Mokdad, Ali H and Morrison, Shane Douglas and Mosser, Jonathan F and Mousavi, Seyyed Meysam and Muriithi, Moses K and Muthupandian, Saravanan and Myint, Chaw-Yin and Naderi, Mehdi and Nagarajan, Ahamarshan Jayaraman and Nguyen, Cuong Tat and Nguyen, Huong Lan Thi and Nonvignon, Justice and Noubiap, Jean Jacques and Oh, In-Hwan and Olagunju, Andrew T and Olusanya, Jacob Olusegun and Olusanya, Bolajoko Olubukunola and Omar Bali, Ahmed and Onwujekwe, Obinna E and Otstavnov, Stanislav S and Otstavnov, Nikita and Owolabi, Mayowa Ojo and Padubidri, Jagadish Rao and Palladino, Raffaele and Panda-Jonas, Songhomitra and Pandey, Anamika and Postma, Maarten J and Prada, Sergio I and Pribadi, Dimas Ria Angga and Rabiee, Mohammad and Rabiee, Navid and Rahim, Fakher and Ranabhat, Chhabi Lal and Rao, Sowmya J and Rathi, Priya and Rawaf, Salman and Rawaf, David Laith and Rawal, Lal and Rawassizadeh, Reza and Rezapour, Aziz and Sabour, Siamak and Sahraian, Mohammad Ali and Salman, Omar Mukhtar and Salomon, Joshua A and Samy, Abdallah M and Sanabria, Juan and Santos, João Vasco and Santric Milicevic, Milena M and Sao Jose, Bruno Piassi and Savic, Miloje and Schwendicke, Falk and Senthilkumaran, Subramanian and Sepanlou, Sadaf G and Serván-Mori, Edson and Setayesh, Hamidreza and Shaikh, Masood Ali and Sheikh, Aziz and Shibuya, Kenji and Shrime, Mark G and Simonetti, Biagio and Singh, Jasvinder A and Singh, Pushpendra and Skryabin, Valentin Yurievich and Soheili, Amin and Soltani, Shahin and Ștefan, Simona Cătălina and Tabarés-Seisdedos, Rafael and Topor-Madry, Roman and Tovani-Palone, Marcos Roberto and Tran, Bach Xuan and Travillian, Ravensara and Undurraga, Eduardo A and Valdez, Pascual R and van Boven, Job F M and Vasankari, Tommi Juhani and Violante, Francesco S and Vlassov, Vasily and Vos, Theo and Wolfe, Charles D A and Wu, Junjie and Yaya, Sanni and Yazdi-Feyzabadi, Vahid and Yip, Paul and Yonemoto, Naohiro and Younis, Mustafa Z and Yu, Chuanhua and Zaidi, Zoubida and Zaman, Sojib Bin and Zastrozhin, Mikhail Sergeevich and Zhang, Zhi-Jiang and Zhao, Yingxi and Murray, Christopher J L and Dieleman, Joseph L (2020) Health sector spending and spending on HIV/AIDS, tuberculosis, and malaria, and development assistance for health: progress towards Sustainable Development Goal 3. The Lancet, 396 (10252). pp. 693-724. ISSN 01406736

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Background Sustainable Development Goal (SDG) 3 aims to "ensure healthy lives and promote well-being for all at all ages". While a substantial effort has been made to quantify progress towards SDG3, less research has focused on tracking spending towards this goal. We used spending estimates to measure progress in financing the priority areas of SDG3, examine the association between outcomes and financing, and identify where resource gains are most needed to achieve the SDG3 indicators for which data are available. Methods We estimated domestic health spending, disaggregated by source (government, out-of-pocket, and prepaid private) from 1995 to 2017 for 195 countries and territories. For disease-specific health spending, we estimated spending for HIV/AIDS and tuberculosis for 135 low-income and middle-income countries, and malaria in 106 malaria-endemic countries, from 2000 to 2017. We also estimated development assistance for health (DAH) from 1990 to 2019, by source, disbursing development agency, recipient, and health focus area, including DAH for pandemic preparedness. Finally, we estimated future health spending for 195 countries and territories from 2018 until 2030. We report all spending estimates in inflation-adjusted 2019 US$, unless otherwise stated. Findings Since the development and implementation of the SDGs in 2015, global health spending has increased, reaching $7.9 trillion (95% uncertainty interval 7.8-8.0) in 2017 and is expected to increase to $11.0 trillion (10.7-11.2) by 2030. In 2017, in low-income and middle-income countries spending on HIV/AIDS was $20.2 billion (17.0-25.0) and on tuberculosis it was $10.9 billion (10.3-11.8), and in malaria-endemic countries spending on malaria was $5.1 billion (4.9-5.4). Development assistance for health was $40.6 billion in 2019 and HIV/AIDS has been the health focus area to receive the highest contribution since 2004. In 2019, $374 million of DAH was provided for pandemic preparedness, less than 1% of DAH. Although spending has increased across HIV/AIDS, tuberculosis, and malaria since 2015, spending has not increased in all countries, and outcomes in terms of prevalence, incidence, and per-capita spending have been mixed. The proportion of health spending from pooled sources is expected to increase from 81.6% (81.6-81.7) in 2015 to 83.1% (82.8-83.3) in 2030. Interpretation Health spending on SDG3 priority areas has increased, but not in all countries, and progress towards meeting the SDG3 targets has been mixed and has varied by country and by target. The evidence on the scale-up of spending and improvements in health outcomes suggest a nuanced relationship, such that increases in spending do not always results in improvements in outcomes. Although countries will probably need more resources to achieve SDG3, other constraints in the broader health system such as inefficient allocation of resources across interventions and populations, weak governance systems, human resource shortages, and drug shortages, will also need to be addressed. Copyright (C) 2020 The Author(s). Published by Elsevier Ltd. Keywords SYSTEMATIC ANALYSIS; GLOBAL BURDEN; 195 COUNTRIES; DISEASE; TERRITORIES; IMPOVERISHMENT; EXPENDITURE; CATASTROPHE; ALLOCATION; DISABILITY

Item Type: Article
Subjects: WA Public Health > WA. 900 Vital Statistics
WC Communicable Diseases > Virus diseases
Divisions: Faculty of Health > Department of Epidemiology
Depositing User: zeynab . bagheri
Date Deposited: 07 Nov 2020 09:32
Last Modified: 07 Nov 2020 09:32

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