Spending on health and HIV/AIDS: domestic health spending and development assistance in 188 countries, 1995–2015
Authors: Joseph L Dieleman, Annie Haakenstad, Angela Micah, Mark Moses, Cristiana Abbafati, Pawan Acharya, Tara Ballav Adhikari, Arsène Kouablan Adou, Aliasghar Ahmad Kiadaliri, Khurshid Alam, Reza Alizadeh-Navaei, Ala'a Alkerwi, Walid Ammar, Carl Abelardo T Antonio, Olatunde Aremu, Solomon Weldegebreal Asgedom, Tesfay Mehari Atey, Leticia Avila-Burgos, Ashish Awasthi, Rakesh Ayer, Hamid Badali, Maciej Banach, Amrit Banstola, Aleksandra Barac, Abate Bekele Belachew, Charles Birungi, Nicola L Bragazzi, Nicholas J K Breitborde, Lucero Cahuana-Hurtado, Josip Car, Ferrán Catalá-López, Abigail Chapin, Lalit Dandona, Rakhi Dandona, Ahmad Daryani, Samath D Dharmaratne, Manisha Dubey, Dumessa Edessa, Erika Eldrenkamp, Babak Eshrati, André Faro, Andrea B Feigl, Ama P Fenny, Florian Fischer, Nataliya Foigt, Kyle J Foreman, Nancy Fullman, Mamata Ghimire, Srinivas Goli, Alemayehu Desalegne Hailu, Samer Hamidi, Hilda L Harb, Simon I Hay, Delia Hendrie, Gloria Ikilezi, Mehdi Javanbakht, Denny John, Jost B Jonas, Alexander Kaldjian, Amir Kasaeian, Jennifer Kates, Ibrahim A Khalil, Young-Ho Khang, Jagdish Khubchandani, Yun Jin Kim, Jonas M Kinge, Soewarta Kosen, Kristopher J Krohn, G Anil Kumar, Hilton Lam, Stefan Listl, Hassan Magdy Abd El Razek, Mohammed Magdy Abd El Razek, Azeem Majeed, Reza Malekzadeh, Deborah Carvalho Malta, George A Mensah, Atte Meretoja, Ted R Miller, Erkin M Mirrakhimov, Fitsum Weldegebreal Mlashu, Ebrahim Mohammed, Shafiu Mohammed, Mohsen Naghavi, Vinay Nangia, Frida Namnyak Ngalesoni, Cuong Tat Nguyen, Trang Huyen Nguyen, Yirga Niriayo, Mehdi Noroozi, Mayowa O Owolabi, David M Pereira, Mostafa Qorbani, Anwar Rafay, Alireza Rafiei, Vafa Rahimi-Movaghar, Rajesh Kumar Rai, Usha Ram, Chhabi Lal Ranabhat, Sarah E Ray, Robert C Reiner, Nafis Sadat, Haniye Sadat Sajadi, João Vasco Santos, Abdur Razzaque Sarker, Benn Sartorius, Maheswar Satpathy, Miloje Savic, Matthew Schneider, Sadaf G Sepanlou, Masood Ali Shaikh, Mehdi Sharif, Jun She, Aziz Sheikh, Mekonnen Sisay, Samir Soneji, Moslem Soofi, Henok Tadesse, Tianchan Tao, Tara Templin, Azeb Gebresilassie Tesema, Subash Thapa, Alan J Thomson, Ruoyan Tobe-Gai, Roman Topor-Madry, Bach Xuan Tran, Khanh Bao Tran, Tung Thanh Tran, Eduardo A Undurraga, Tommi Vasankari, Francesco S Violante, Tissa Wijeratne, Gelin Xu, Naohiro Yonemoto, Mustafa Z Younis, Chuanhua Yu, Maysaa El Sayed Zaki, Lei Zhou, Bianca Zlavog, Christopher J L Murray
Journal: The Lancet (2018)

Comparable estimates of health spending are crucial for the assessment of health systems and to optimally deploy health resources. The methods used to track health spending continue to evolve, but little is known about the distribution of spending across diseases. We developed improved estimates of health spending by source, including development assistance for health, and, for the first time, estimated HIV/AIDS spending on prevention and treatment and by source of funding, for 188 countries.We collected published data on domestic health spending, from 1995 to 2015, from a diverse set of international agencies. We tracked development assistance for health from 1990 to 2017. We also extracted 5385 datapoints about HIV/AIDS spending, between 2000 and 2015, from online databases, country reports, and proposals submitted to multilateral organisations. We used spatiotemporal Gaussian process regression to generate complete and comparable estimates for health and HIV/AIDS spending. We report most estimates in 2017 purchasing-power parity-adjusted dollars and adjust all estimates for the effect of inflation.Between 1995 and 2015, global health spending per capita grew at an annualised rate of 3·1% (95% uncertainty interval [UI] 3·1 to 3·2), with growth being largest in upper-middle-income countries (5·4% per capita [UI 5·3-5·5]) and lower-middle-income countries (4·2% per capita [4·2-4·3]). In 2015, $9·7 trillion (9·7 trillion to 9·8 trillion) was spent on health worldwide. High-income countries spent $6·5 trillion (6·4 trillion to 6·5 trillion) or 66·3% (66·0 to 66·5) of the total in 2015, whereas low-income countries spent $70·3 billion (69·3 billion to 71·3 billion) or 0·7% (0·7 to 0·7). Between 1990 and 2017, development assistance for health increased by 394·7% ($29·9 billion), with an estimated $37·4 billion of development assistance being disbursed for health in 2017, of which $9·1 billion (24·2%) targeted HIV/AIDS. Between 2000 and 2015, $562·6 billion (531·1 billion to 621·9 billion) was spent on HIV/AIDS worldwide. Governments financed 57·6% (52·0 to 60·8) of that total. Global HIV/AIDS spending peaked at 49·7 billion (46·2-54·7) in 2013, decreasing to $48·9 billion (45·2 billion to 54·2 billion) in 2015. That year, low-income and lower-middle-income countries represented 74·6% of all HIV/AIDS disability-adjusted life-years, but just 36·6% (34·4 to 38·7) of total HIV/AIDS spending. In 2015, $9·3 billion (8·5 billion to 10·4 billion) or 19·0% (17·6 to 20·6) of HIV/AIDS financing was spent on prevention, and $27·3 billion (24·5 billion to 31·1 billion) or 55·8% (53·3 to 57·9) was dedicated to care and treatment.From 1995 to 2015, total health spending increased worldwide, with the fastest per capita growth in middle-income countries. While these national disparities are relatively well known, low-income countries spent less per person on health and HIV/AIDS than did high-income and middle-income countries. Furthermore, declines in development assistance for health continue, including for HIV/AIDS. Additional cuts to development assistance could hasten this decline, and risk slowing progress towards global and national goals.The Bill & Melinda Gates Foundation.