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,The Lancet

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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
The Lancet ( IF 168.9 ) Pub Date : 2021-09-22 , DOI: 10.1016/s0140-6736(21)01258-7
Angela E Micah , Ian E Cogswell , Brandon Cunningham , Satoshi Ezoe , Anton C Harle , Emilie R Maddison , Darrah McCracken , Shuhei Nomura , Kyle E Simpson , Hayley N Stutzman , Golsum Tsakalos , Lindsey E Wallace , Yingxi Zhao , Rahul R Zende , Cristiana Abbafati , Michael Abdelmasseh , Aidin Abedi , Kedir Hussein Abegaz , E S Abhilash , Hassan Abolhassani , Michael R M Abrigo , Tara Ballav Adhikari , Saira Afzal , Bright Opoku Ahinkorah , Sepideh Ahmadi , Haroon Ahmed , Muktar Beshir Ahmed , Tarik Ahmed Rashid , Marjan Ajami , Budi Aji , Yonas Akalu , Chisom Joyqueenet Akunna , Hanadi Al Hamad , Khurshid Alam , Fahad Mashhour Alanezi , Turki M Alanzi , Yosef Alemayehu , Robert Kaba Alhassan , Cyrus Alinia , Syed Mohamed Aljunid , Sami Almustanyir Almustanyir , Nelson Alvis-Guzman , Nelson J Alvis-Zakzuk , Saeed Amini , Mostafa Amini-Rarani , Hubert Amu , Robert Ancuceanu , Catalina Liliana Andrei , Tudorel Andrei , Blake Angell , Mina Anjomshoa , Carl Abelardo T Antonio , Catherine M Antony , Muhammad Aqeel , Jalal Arabloo , Morteza Arab-Zozani , Timur Aripov , Alessandro Arrigo , Tahira Ashraf , Desta Debalkie Atnafu , Marcel Ausloos , Leticia Avila-Burgos , Asma Tahir Awan , Getinet Ayano , Martin Amogre Ayanore , Samad Azari , Gulrez Shah Azhar , Tesleem Kayode Babalola , Mohammad Amin Bahrami , Atif Amin Baig , Maciej Banach , Nastaran Barati , Till Winfried Bärnighausen , Amadou Barrow , Sanjay Basu , Bernhard T Baune , Mohsen Bayati , Habib Benzian , Adam E Berman , Akshaya Srikanth Bhagavathula , Nikha Bhardwaj , Pankaj Bhardwaj , Sonu Bhaskar , Sadia Bibi , Ali Bijani , Virginia Bodolica , Nicola Luigi Bragazzi , Dejana Braithwaite , Nicholas J K Breitborde , Alexey V Breusov , Nikolay Ivanovich Briko , Reinhard Busse , Lucero Cahuana-Hurtado , Emily Joy Callander , Luis Alberto Cámera , Carlos A Castañeda-Orjuela , Ferrán Catalá-López , Jaykaran Charan , Souranshu Chatterjee , Soosanna Kumary Chattu , Vijay Kumar Chattu , Simiao Chen , Arrigo Francesco Giuseppe Cicero , Omid Dadras , Saad M A Dahlawi , Xiaochen Dai , Koustuv Dalal , Lalit Dandona , Rakhi Dandona , Dragos Virgil Davitoiu , Jan-Walter De Neve , Antonio Reis de Sá-Junior , Edgar Denova-Gutiérrez , Deepak Dhamnetiya , Samath Dhamminda Dharmaratne , Leila Doshmangir , John Dube , Elham Ehsani-Chimeh , Maysaa El Sayed Zaki , Maha El Tantawi , Sharareh Eskandarieh , Farshad Farzadfar , Tomas Y Ferede , Florian Fischer , Nataliya A Foigt , Alberto Freitas , Sara D Friedman , Takeshi Fukumoto , Nancy Fullman , Peter Andras Gaal , Mohamed M Gad , MA Garcia-Gordillo , Tushar Garg , Mansour Ghafourifard , Ahmad Ghashghaee , Asadollah Gholamian , Ali Gholamrezanezhad , Ghozali Ghozali , Syed Amir Gilani , Ionela-Roxana Glăvan , Ekaterina Vladimirovna Glushkova , Salime Goharinezhad , Mahaveer Golechha , Srinivas Goli , Avirup Guha , Veer Bala Gupta , Vivek Kumar Gupta , Annie Haakenstad , Mohammad Rifat Haider , Alemayehu Hailu , Samer Hamidi , Asif Hanif , Harapan Harapan , Risky Kusuma Hartono , Ahmed I Hasaballah , Shoaib Hassan , Mohamed H Hassanein , Khezar Hayat , Mohamed I Hegazy , Golnaz Heidari , Delia Hendrie , Ileana Heredia-Pi , Claudiu Herteliu , Kamal Hezam , Ramesh Holla , Sheikh Jamal Hossain , Mehdi Hosseinzadeh , Sorin Hostiuc , Tanvir M Huda , Bing-Fang Hwang , Ivo Iavicoli , Bulat Idrisov , Olayinka Stephen Ilesanmi , Seyed Sina Naghibi Irvani , Sheikh Mohammed Shariful Islam , Nahlah Elkudssiah Ismail , Gaetano Isola , Mohammad Ali Jahani , Nader Jahanmehr , Mihajlo Jakovljevic , Manthan Dilipkumar Janodia , Tahereh Javaheri , Sathish Kumar Jayapal , Ranil Jayawardena , Seyed Behzad Jazayeri , Ravi Prakash Jha , Jost B Jonas , Tamas Joo , Farahnaz Joukar , Mikk Jürisson , Billingsley Kaambwa , Rohollah Kalhor , Tanuj Kanchan , Himal Kandel , Behzad Karami Matin , Salah Eddin Karimi , Getinet Kassahun , Gbenga A Kayode , Ali Kazemi Karyani , Leila Keikavoosi-Arani , Yousef Saleh Khader , Himanshu Khajuria , Rovshan Khalilov , Mohammad Khammarnia , Junaid Khan , Jagdish Khubchandani , Neda Kianipour , Gyu Ri Kim , Yun Jin Kim , Adnan Kisa , Sezer Kisa , Stefan Kohler , Soewarta Kosen , Rajasekaran Koteeswaran , Sindhura Lakshmi Koulmane Laxminarayana , Ai Koyanagi , Kewal Krishan , G Anil Kumar , Dian Kusuma , Demetris Lamnisos , Van Charles Lansingh , Anders O Larsson , Savita Lasrado , Long Khanh Dao Le , Shaun Wen Huey Lee , Yeong Yeh Lee , Stephen S Lim , Stany W Lobo , Rafael Lozano , Hassan Magdy Abd El Razek , Muhammed Magdy Abd El Razek , Mokhtar Mahdavi Mahdavi , Azeem Majeed , Alaa Makki , Afshin Maleki , Reza Malekzadeh , Ana Laura Manda , Fariborz Mansour-Ghanaei , Mohammad Ali Mansournia , Carlos Alberto Marrugo Arnedo , Adolfo Martinez-Valle , Seyedeh Zahra Masoumi , Richard James Maude , Martin McKee , Carlo Eduardo Medina-Solís , Ritesh G Menezes , Atte Meretoja , Tuomo J Meretoja , Mohamed Kamal Mesregah , Tomislav Mestrovic , Neda Milevska Kostova , Ted R Miller , GK Mini , Andreea Mirica , Erkin M Mirrakhimov , Bahram Mohajer , Teroj Abdulrahman Mohamed , Mokhtar Mohammadi , Abdollah Mohammadian-Hafshejani , Shafiu Mohammed , Modhurima Moitra , Ali H Mokdad , Mariam Molokhia , Mohammad Ali Moni , Yousef Moradi , Jakub Morze , Seyyed Meysam Mousavi , Christine Mpundu-Kaambwa , Moses K Muriithi , Saravanan Muthupandian , Ahamarshan Jayaraman Nagarajan , Mukhammad David Naimzada , Vinay Nangia , Atta Abbas Naqvi , Aparna Ichalangod Narayana , Bruno Ramos Nascimento , Muhammad Naveed , Biswa Prakash Nayak , Javad Nazari , Rawlance Ndejjo , Ionut Negoi , Sandhya Neupane Kandel , Trang Huyen Nguyen , Justice Nonvignon , Jean Jacques Noubiap , Vincent Ebuka Nwatah , Bogdan Oancea , Foluke Adetola Ogunyemi Ojelabi , Andrew T Olagunju , Babayemi Oluwaseun Olakunde , Stefano Olgiati , Jacob Olusegun Olusanya , Obinna E Onwujekwe , Adrian Otoiu , Nikita Otstavnov , Stanislav S Otstavnov , Mayowa O Owolabi , Jagadish Rao Padubidri , Raffaele Palladino , Songhomitra Panda-Jonas , Eun-Cheol Park , Fatemeh Pashazadeh Kan , Shrikant Pawar , Hamidreza Pazoki Toroudi , David M Pereira , Arokiasamy Perianayagam , Konrad Pesudovs , Cristiano Piccinelli , Maarten J Postma , Sergio I Prada , Mohammad Rabiee , Navid Rabiee , Fakher Rahim , Vafa Rahimi-Movaghar , Mohammad Hifz Ur Rahman , Mosiur Rahman , Amir Masoud Rahmani , Usha Ram , Chhabi Lal Ranabhat , Priyanga Ranasinghe , Chythra R Rao , Priya Rathi , David Laith Rawaf , Salman Rawaf , Lal Rawal , Reza Rawassizadeh , Robert C Reiner Jr , Andre M N Renzaho , Bhageerathy Reshmi , Mavra A Riaz , Rezaul Karim Ripon , Anas M Saad , Mohammad Ali Sahraian , Maitreyi Sahu , Joseph S Salama , Sana Salehi , Abdallah M Samy , Juan Sanabria , Francesco Sanmarchi , João Vasco Santos , Milena M Santric-Milicevic , Brijesh Sathian , Miloje Savic , Deepak Saxena , Mehdi Sayyah , Falk Schwendicke , Subramanian Senthilkumaran , Sadaf G Sepanlou , Allen Seylani , Saeed Shahabi , Masood Ali Shaikh , Aziz Sheikh , Adithi Shetty , Pavanchand H Shetty , Kenji Shibuya , Mark G Shrime , Kanwar Hamza Shuja , Jasvinder A Singh , Valentin Yurievich Skryabin , Anna Aleksandrovna Skryabina , Shahin Soltani , Moslem Soofi , Emma Elizabeth Spurlock , Simona Cătălina Stefan , Viktória Szerencsés , Miklós Szócska , Rafael Tabarés-Seisdedos , Biruk Wogayehu Taddele , Yonas Getaye Tefera , Aravind Thavamani , Ruoyan Tobe-Gai , Roman Topor-Madry , Marcos Roberto Tovani-Palone , Bach Xuan Tran , Lorainne Tudor Car , Anayat Ullah , Saif Ullah , Nasir Umar , Eduardo A Undurraga , Pascual R Valdez , Tommi Juhani Vasankari , Jorge Hugo Villafañe , Francesco S Violante , Vasily Vlassov , Bay Vo , Sebastian Vollmer , Theo Vos , Giang Thu Vu , Linh Gia Vu , Richard G Wamai , Andrea Werdecker , Mesfin Agachew Woldekidan , Befikadu Legesse Wubishet , Gelin Xu , Sanni Yaya , Vahid Yazdi-Feyzabadi , Vahit Yiğit , Paul Yip , Birhanu Wubale Yirdaw , Naohiro Yonemoto , Mustafa Z Younis , Chuanhua Yu , Ismaeel Yunusa , Telma Zahirian Moghadam , Hamed Zandian , Mikhail Sergeevich Zastrozhin , Anasthasia Zastrozhina , Zhi-Jiang Zhang , Arash Ziapour , Yves Miel H Zuniga , Simon I Hay , Christopher J L Murray , Joseph L Dieleman

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.

中文翻译：

跟踪卫生和 COVID-19 的发展援助：对 1990 年至 2050 年 204 个国家和地区的发展援助、政府、自付费用和其他私人卫生支出的审查

背景

COVID-19 的迅速传播重新引发人们对全球卫生系统融资方式的关注，尤其是在突发公共卫生事件期间。发展援助是许多低收入国家卫生筹资的重要来源，但人们对其中有多少资金用于应对 COVID-19 却知之甚少。我们的目标是将针对 COVID-19 的卫生发展援助置于全球卫生筹资更广泛趋势的背景下，并估算 1995 年至 2050 年的卫生总支出以及 2020 年针对 COVID-19 的发展援助。

方法

我们估算了国内卫生支出和卫生发展援助，得出 204 个国家和地区的卫生部门总支出估算。我们利用世界卫生组织全球卫生支出数据库的数据来估算国内卫生支出。为了对卫生发展援助进行估算，我们依靠主要国际发展机构在线数据库中的项目级支出数据以及年度财务报表和收入来源信息报告。为了调整我们对 2020 年的估计，以包括与 COVID-19 相关的支出，我们从更广泛的数据库中提取了有关承诺和支出的项目数据（因为并非所有用于估计历史序列的数据源都延续到 2020 年），包括联合国人道主义援助办公室财务跟踪服务和国际援助透明度倡议。我们报告了所有历史和未来支出预测，单位为经通货膨胀调整的 2020 年美元、2020 年人均美元、经购买力平价调整的人均美元以及占国内生产总值的比例。我们使用各种模型来计算 2050 年的未来医疗支出。

发现

2019 年，全球医疗支出达到 8·8 万亿美元（95% 不确定性区间 [UI] 8·7–8·8）或人均 1132 美元（1119–1143）。不同收入群体和地理区域之间的健康支出各不相同。其中，40·40 亿美元（0·5%，95% UI 0·5–0·5）是向低收入和中等收入国家提供的卫生发展援助，占 24·6%（UI 0·5-0·5） 24·0–25·1) 的低收入国家总支出。我们估计 2020 年支付了 54·80 亿美元的卫生发展援助。其中，13·70 亿美元专门用于 COVID-19 卫生应对措施。新承诺投入 12·30 亿美元，并从现有卫生项目中重新利用 1·40 亿美元。其中 3·10 亿美元（22·4%）的资金主要用于国家级协调，2·40 亿美元（17·9%）用于供应链和物流。尽管拉丁美洲报告 2020 年低收入或中等收入国家的 COVID-19 死亡人数占记录总数的 34·3%，但只有 7.14 万美元 (7·7%) 的 COVID-19 卫生发展援助流向了拉丁美洲. 预计到 2050 年，人均卫生支出将增至 1519 美元（1448-1591），尽管各国之间的支出预计仍将存在差异。