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Public financing of health in developing countries: a cross-national systematic analysis

Lu, C.; Schneider, M.T.; Gubbins, P.; Leach-Kemon, K.; Jamison, D.; Murray, C.J.L. (2010) CC

Government spending on health from domestic sources is an important indicator of a government's commitment to the health of its people, and is essential for the sustainability of health programmes. We aimed to systematically analyse all data sources available for government spending on health in dev... more

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Estimates of aid for reproductive, maternal, newborn, and child health: findings from application of the Muskoka2 method, 2002–17

Dingle, A.; Schäferhoff, M.; Borghi, J. et al. The Lancet (2020) CC

Background Four methods have previously been used to track aid for reproductive, maternal, newborn, and child health (RMNCH). At a meeting of donors and stakeholders in May, 2018, a single, agreed method was requested to produce accurate, predictable, transparent, and up-to-date estimates that coul...d be used for analyses from both donor and recipient perspectives. Muskoka2 was developed to meet these needs. We describe Muskoka2 and present estimates of levels and trends in aid for RMNCH in 2002–17, with a focus on the latest estimates for 2017. Methods Muskoka2 is an automated algorithm that generates disaggregated estimates of aid for reproductive health, maternal and newborn health, and child health at the global, donor, and recipient-country levels. We applied Muskoka2 to the Organisation for Economic Co-operation and Development's Creditor Reporting System (CRS) aid activities database to generate estimates of RMNCH disbursements in 2002–17. The percentage of disbursements that benefit RMNCH was determined using CRS purpose codes for all donors except Gavi, the Vaccine Alliance; the UN Population Fund; and UNICEF; for which fixed percentages of aid were considered to benefit RMNCH. We analysed funding by donor for the 20 largest donors, by recipient-country income group, and by recipient for the 16 countries with the greatest RMNCH need, defined as the countries with the worst levels in 2015 on each of seven health indicators. Findings After 3 years of stagnation, reported aid for RMNCH reached $15·9 billion in 2017, the highest amount ever reported. Among donors reporting in both 2016 and 2017, aid increased by 10% ($1·4 billion) to $15·4 billion between 2016 and 2017. Child health received almost half of RMNCH disbursements in 2017 (46%, $7·4 billion), followed by reproductive health (34%, $5·4 billion), and maternal and newborn health (19%, $3·1 billion). The USA ($5·8 billion) and the UK ($1·6 billion) were the largest bilateral donors, disbursing 46% of all RMNCH funding in 2017 (including shares of their core contributions to multilaterals). The Global Fund and Gavi were the largest multilateral donors, disbursing $1·7 billion and $1·5 billion, respectively, for RMNCH from their core budgets. The proportion of aid for RMNCH received by low-income countries increased from 31% in 2002 to 52% in 2017. Nigeria received 7% ($1·1 billion) of all aid for RMNCH in 2017, followed by Ethiopia (6%, $876 million), Kenya (5%, $754 million), and Tanzania (5%, $751 million). Interpretation Muskoka2 retains the speed, transparency, and donor buy-in of the G8's previous Muskoka approach and incorporates eight innovations to improve precision. Although aid for RMNCH increased in 2017, low-income and middle-income countries still experience substantial funding gaps and threats to future funding. Maternal and newborn health receives considerably less funding than reproductive health or child health, which is a persistent issue requiring urgent attention. Funding Bill & Melinda Gates Foundation; Partnership for Maternal, Newborn & Child Health. more

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National spending on health by source for 184 countries between 2013 and 2040

Dieleman, J.; Templin, T.; Sadat, N. et al. (2016) CC

A general consensus exists that as a country develops economically, health spending per capita rises and the share of that spending that is prepaid through government or private mechanisms also rises. However, the speed and magnitude of these changes vary substantially across countries, even at simi...lar levels of development. In this study, we use past trends and relationships to estimate future health spending, disaggregated by the source of those funds, to identify the financing trajectories that are likely to occur if current policies and trajectories evolve as expected. Methods We extracted data from WHO's Health Spending Observatory and the Institute for Health Metrics and Evaluation's Financing Global Health 2015 report. We converted these data to a common purchasing power-adjusted and inflation-adjusted currency. We used a series of ensemble models and observed empirical norms to estimate future government out-of-pocket private prepaid health spending and development assistance for health. We aggregated each country's estimates to generate total health spending from 2013 to 2040 for 184 countries. We compared these estimates with each other and internationally recognised benchmarks. Findings Global spending on health is expected to increase from US$7·83 trillion in 2013 to $18·28 (uncertainty interval 14·42–22·24) trillion in 2040 (in 2010 purchasing power parity-adjusted dollars). We expect per-capita health spending to increase annually by 2·7% (1·9–3·4) in high-income countries, 3·4% (2·4–4·2) in upper-middle-income countries, 3·0% (2·3–3·6) in lower-middle-income countries, and 2·4% (1·6–3·1) in low-income countries. Given the gaps in current health spending, these rates provide no evidence of increasing parity in health spending. In 1995 and 2015, low-income countries spent $0·03 for every dollar spent in high-income countries, even after adjusting for purchasing power, and the same is projected for 2040. Most importantly, health spending in many low-income countries is expected to remain low. Estimates suggest that, by 2040, only one (3%) of 34 low-income countries and 36 (37%) of 98 middle-income countries will reach the Chatham House goal of 5% of gross domestic product consisting of government health spending. Interpretation Despite remarkable health gains, past health financing trends and relationships suggest that many low-income and lower-middle-income countries will not meet internationally set health spending targets and that spending gaps between low-income and high-income countries are unlikely to narrow unless substantive policy interventions occur. Although gains in health system efficiency can be used to make progress, current trends suggest that meaningful increases in health system resources will require concerted action. Funding Bill & Melinda Gates Foundation. more

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Consequences of the US budget cuts and the dissolution of USAID: An analysis and recommendations for action for stakeholders in international development cooperation

Liebau L., Rüppel T., Schottmayer K. medmissio (2025) CC

This publication provides a problem analysis of the U.S. cuts in global health and derives concrete recommendations for action for medical actors. The focus is on analyzing the direct effects on health-specific development cooperation.

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Consequences of the US budget cuts and the dissolution of USAID: An analysis and recommendations for action for stakeholders in international development cooperation - Executive Summary

Liebau L., Rüppel T., Schottmayer K. medmissio (2025) CC

This two-page summary provides a problem analysis of the U.S. cuts in global health and derives concrete recommendations for action for medical actors. The focus is on analyzing the direct effects on health-specific development cooperation.

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Irreplaceable, effective, affordable, responsible: Why ODA is crucial for global health

Tilman Rüppel and Joachim Rüppel medmissio (2025) CC

This publication uses graphics to explain the importance of development cooperation in general and for health in particular. Financial contributions in the context of development cooperation have proven to be indispensable, effective, affordable and responsible in recent decades.

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Health for all: transforming economies to deliver what matters: final report of the WHO Council on the Economics of Health for All: executive summary

World Health Organisation (WHO) (2024) C_WHO

As of May 2023, COVID-19 may no longer be classified as a public health emergency of international concern, but we must not ignore the deep structural problems it has revealed in our economy.

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Santé pour tous: transformer les économies pour offrir ce qui compte : rapport final du Conseil de l’OMS sur l’économie de la santé pour tous : résumé d’orientation

World Health Organisation (WHO) (2024) C_WHO

En mai 2023, la COVID-19 n’est peut-être plus classifiée en tant qu’urgence de santé publique d’envergure internationale mais nous ne devons pas ignorer les profonds problèmes structurels qu’elle a révélé dans notre économie. La santé est un droit humain fondamental et le temps est... more

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Stark choices: exploring health sector costs of policy responses to COVID-19 in low-income and middle-income countries

Torres-Rueda S.; S. Sweeney; F. Bozzani et al. BMJ Global Health (2021) C2

COVID-19 has altered health sector capacity in low-income and middle-income countries (LMICs). Cost data to inform evidence-based priority setting are urgently needed. Consequently, in this paper, we calculate the full economic health sector costs of COVID-19 clinical management in 79 LMICs under di... more

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Read me – About the Health Financing Toolbox
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Tilman Rüppel medmissio (2024) CC

The Health Financing Toolbox is designed to equip development cooperation stakeholders with essential information on the internal and external financing of nation states, with a particular emphasis on health financing. To achieve this, the Health Financing Toolbox includes a comprehensive collection... more

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Health Financing Progress Matrix assessment, Zambia 2024

World Health Organisation (WHO) (2024) C_WHO

This report summarizes the findings of the Health Financing Progress Matrix assessment for Zambia. Recognizing the remarkable progress towards UHC made by the country over the past twenty years, the report also highlights weaknesses in the current health financing system and, extending from this, th... more

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Health financing for the COVID-19 response: Process guide for national budgetary dialogue. ACT-A Health Systems Connector

World Health Organization (WHO), World Bank, Global Financing Facility (GFF) et al. World Health Organization (WHO) (2021) CC

Annual and medium-term budget preparation processes are the platforms through which specific plans are transformed into actual resource allocation decisions. The aim of this Process Guide is to support key stakeholders involved in these processes (such as the Cabinet, Ministries of Finance and Healt... more

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Health Financing Progress Matrix assessment, Zambia 2024

World Health Organisation (WHO) (2024) C_WHO

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Salud para todos: transformando la economía hacia lo que importa: informe final del Consejo de la OMS sobre la Economía de la Salud para Todos: resumen ejecutivo

World Health Organisation (WHO) (2024) C_WHO

Aunque en mayo de 2023 la pandemia de COVID-19 ya no se consideraba una emergencia de salud pública de alcance internacional, no debemos pasar por alto los profundos problemas estructurales que ha puesto de manifiesto en nuestra economía. La salud es un derecho humano fundamental, y actualmente es... more

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Financialisation: a 21st century commercial determinant of health equity

Friel S., Schram A., Frank N., et al. Lancet Public Health (2024) CC

In 21st century capitalism, financial markets reign supreme. The elevation of investing, trading, and speculating as a way of making profit has shifted economic power towards institutional investors and enhanced the power of financial capital. Financialisation has introduced uncertainty in the commi... more

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Health Namibia Budget Brief

UNICEF (2022) C_UNICEF

Strengthening health financing to accelerate progress towards universal health coverage. Total Government Health Expenditure exceeds the commitment by African Union member states to commit at least 15% of their budgets to the health sector. With a sector allocation of 16.6% of total budget in 2022/... more

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Examining malaria treatment and prevention spending efficiency in malaria-endemic countries, 2000–2020

Apeagyei, A. E.; I. Cogswell, N.K. Patel, N.K.; et al. (2024) CC2

Malar J 23, 333 (2024). https://doi.org/10.1186/s12936-024-05165-w. Prioritization of spending on prevention, anti-malarial medicines, and health systems strengthening can fight incident cases and fatalities simultaneously, especially in resource-scarce, malaria-endemic countries. Furthermore, imp... more

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2025 Global AIDS Update — AIDS, Crisis and the Power to Transform
recommended

UNAIDS (2025) C_WHO

A historic funding crisis is threatening to unravel decades of progress unless countries can make radical shifts to HIV programming and funding. The report highlights the impact that the sudden, large-scale funding cuts from international donors are having on countries most affected by HIV. Yet it a... more

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2025 Global AIDS Update — AIDS, Crisis and the Power to Transform. Excecutive Summary
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UNAIDS (2025) C_WHO

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Social protection programmes in Malawi

Government of Malawi; Unicef (2022) C_UNICEF

Social protection programmes in Malawi ensure that those most in need get the essential assistance they require.Social protection programmes help the most vulnerable, including the elderly, ultra-poor, disabled, and children

Read me – About the Health Financing Toolbox recommended

2025 Global AIDS Update — AIDS, Crisis and the Power to Transform recommended

2025 Global AIDS Update — AIDS, Crisis and the Power to Transform. Excecutive Summary recommended New

Read me – About the Health Financing Toolbox
recommended

2025 Global AIDS Update — AIDS, Crisis and the Power to Transform
recommended

2025 Global AIDS Update — AIDS, Crisis and the Power to Transform. Excecutive Summary
recommended

New