Health sector spending and spending on HIV/AIDS, tuberculosis, and malaria, and development assistance for health: progress towards Sustainable Development Goal 3
Authors: Angela E Micah, Yanfang Su, Steven D Bachmeier, Abigail Chapin, Ian E Cogswell, Sawyer W Crosby, Brandon Cunningham, Anton C Harle, Emilie R Maddison, Modhurima Moitra, Maitreyi Sahu, Matthew T 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 Olusola Akinyemi, Khurshid Alam, Saqib Ali, Cyrus Alinia, Vahid Alipour, Syed Mohamed Aljunid, Ali Almasi, Nelson Alvis-Guzman, Robert Ancuceanu, Tudorel Andrei, Catalina Liliana Andrei, Mina Anjomshoa, Carl Abelardo T Antonio, Jalal Arabloo, Morteza Arab-Zozani, Olatunde Aremu, Desta Debalkie Atnafu, Marcel Ausloos, Leticia Avila-Burgos, Martin Amogre Ayanore, Samad Azari, Tesleem Kayode Babalola, Mojtaba Bagherzadeh, Atif Amin Baig, Ahad Bakhtiari, Maciej Banach, Srikanta K Banerjee, Till Winfried Bärnighausen, Sanjay Basu, Bernhard T Baune, Mohsen Bayati, Adam E Berman, Reshmi Bhageerathy, Pankaj Bhardwaj, Mehdi Bohluli, Reinhard Busse, Lucero Cahuana-Hurtado, Luis LA Alberto Cámera, Carlos A Castañeda-Orjuela, Ferrán Catalá-López, Muge Cevik, Vijay Kumar Chattu, Lalit Dandona, Rakhi Dandona, Mostafa Dianatinasab, Hoa Thi Do, Leila Doshmangir, Maha El Tantawi, Sharareh Eskandarieh, Firooz Esmaeilzadeh, Anwar Faraj, Farshad Farzadfar, Florian Fischer, Nataliya A Foigt, Nancy Fullman, Mohamed M 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 Herteliu, Michael K Hole, Mehdi Hosseinzadeh, Sorin Hostiuc, Tanvir M Huda, Ayesha Humayun, Bing-Fang Hwang, Olayinka Stephen Ilesanmi, Usman Iqbal, Seyed Sina N Irvani, Sheikh Mohammed Shariful Islam, M Mofizul Islam, Mohammad Ali Jahani, Mihajlo Jakovljevic, 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 Kisa, Stefan Kohler, Hamidreza Komaki, Soewarta Kosen, Anirudh Kotlo, Ai Koyanagi, G Anil Kumar, Dian Kusuma, Van C Lansingh, Anders O Larsson, Savita Lasrado, Shaun Wen Huey Lee, Lee-Ling Lim, Rafael Lozano, Hassan Magdy Abd El Razek, Mokhtar Mahdavi Mahdavi, Shokofeh Maleki, Reza Malekzadeh, Fariborz Mansour-Ghanaei, Mohammad Ali Mansournia, Lorenzo Giovanni Mantovani, Gabriel Martinez, Seyedeh Zahra Masoumi, Benjamin Ballard Massenburg, Ritesh G Menezes, Endalkachew Worku Mengesha, Tuomo J Meretoja, Atte Meretoja, Tomislav Mestrovic, Neda Milevska Kostova, Ted R Miller, Andreea Mirica, Erkin M Mirrakhimov, Masoud Moghadaszadeh, Bahram Mohajer, Efat Mohamadi, Aso Mohammad Darwesh, Abdollah Mohammadian-Hafshejani, Reza Mohammadpourhodki, Shafiu Mohammed, Farnam Mohebi, Ali H Mokdad, Shane Douglas Morrison, Jonathan F Mosser, Seyyed Meysam Mousavi, Moses K Muriithi, Saravanan Muthupandian, 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 Olubukunola Olusanya, Ahmed Omar Bali, Obinna E Onwujekwe, Stanislav S Otstavnov, Nikita Otstavnov, Mayowa Ojo 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 Mukhtar Salman, Joshua A Salomon, Abdallah M Samy, Juan Sanabria, João Vasco Santos, Milena M Santric Milicevic, Bruno Piassi Sao Jose, 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 Topor-Madry, Marcos Roberto Tovani-Palone, Bach Xuan Tran, Ravensara Travillian, Eduardo A Undurraga, Pascual R Valdez, Job F M van Boven, Tommi Juhani Vasankari, Francesco S Violante, Vasily Vlassov, Theo Vos, Charles D A Wolfe, Junjie Wu, Sanni Yaya, Vahid Yazdi-Feyzabadi, Paul Yip, Naohiro Yonemoto, Mustafa Z Younis, Chuanhua Yu, Zoubida Zaidi, Sojib Bin Zaman, Mikhail Sergeevich Zastrozhin, Zhi-Jiang Zhang, Yingxi Zhao, Christopher J L Murray, Joseph L Dieleman
Journal: The Lancet (2020)

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.