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

2020; Elsevier BV; Volume: 396; Issue: 10252 Linguagem: Inglês

10.1016/s0140-6736(20)30608-5

1474-547X

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

Global Health Care Issues

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.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.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.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.The Bill & Melinda Gates Foundation.