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1. 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

Author

Micah, AE, Cogswell, IE, Cunningham, B, Ezoe, S, Harle, AC, Maddison, ER, McCracken, D, Nomura, S, Simpson, KE, Stutzman, HN, Tsakalos, G, Wallace, LE, Zhao, Y, Zende, RR, Abbafati, C, Abdelmasseh, M, Abedi, A, Abegaz, KH, Abhilash, ES, Abolhassani, H, Abrigo, MRM, Adhikari, TB, Afzal, S, Ahinkorah, BO, Ahmadi, S, Ahmed, H, Ahmed, MB, Ahmed Rashid, T, Ajami, M, Aji, B, Akalu, Y, Akunna, CJ, Al Hamad, H, Alam, K, Alanezi, FM, Alanzi, TM, Alemayehu, Y, Alhassan, RK, Alinia, C, Aljunid, SM, Almustanyir, SA, Alvis-Guzman, N, Alvis-Zakzuk, NJ, Amini, S, Amini-Rarani, M, Amu, H, Ancuceanu, R, Andrei, CL, Andrei, T, Angell, B, Anjomshoa, M, Antonio, CAT, Antony, CM, Aqeel, M, Arabloo, J, Arab-Zozani, M, Aripov, T, Arrigo, A, Ashraf, T, Atnafu, DD, Ausloos, M, Avila-Burgos, L, Awan, AT, Ayano, G, Ayanore, MA, Azari, S, Azhar, GS, Babalola, TK, Bahrami, MA, Baig, AA, Banach, M, Barati, N, Bärnighausen, TW, Barrow, A, Basu, S, Baune, BT, Bayati, M, Benzian, H, Berman, AE, Bhagavathula, AS, Bhardwaj, N, Bhardwaj, P, Bhaskar, S, Bibi, S, Bijani, A, Bodolica, V, Gupta, V, Islam, Shariful, Micah, AE, Cogswell, IE, Cunningham, B, Ezoe, S, Harle, AC, Maddison, ER, McCracken, D, Nomura, S, Simpson, KE, Stutzman, HN, Tsakalos, G, Wallace, LE, Zhao, Y, Zende, RR, Abbafati, C, Abdelmasseh, M, Abedi, A, Abegaz, KH, Abhilash, ES, Abolhassani, H, Abrigo, MRM, Adhikari, TB, Afzal, S, Ahinkorah, BO, Ahmadi, S, Ahmed, H, Ahmed, MB, Ahmed Rashid, T, Ajami, M, Aji, B, Akalu, Y, Akunna, CJ, Al Hamad, H, Alam, K, Alanezi, FM, Alanzi, TM, Alemayehu, Y, Alhassan, RK, Alinia, C, Aljunid, SM, Almustanyir, SA, Alvis-Guzman, N, Alvis-Zakzuk, NJ, Amini, S, Amini-Rarani, M, Amu, H, Ancuceanu, R, Andrei, CL, Andrei, T, Angell, B, Anjomshoa, M, Antonio, CAT, Antony, CM, Aqeel, M, Arabloo, J, Arab-Zozani, M, Aripov, T, Arrigo, A, Ashraf, T, Atnafu, DD, Ausloos, M, Avila-Burgos, L, Awan, AT, Ayano, G, Ayanore, MA, Azari, S, Azhar, GS, Babalola, TK, Bahrami, MA, Baig, AA, Banach, M, Barati, N, Bärnighausen, TW, Barrow, A, Basu, S, Baune, BT, Bayati, M, Benzian, H, Berman, AE, Bhagavathula, AS, Bhardwaj, N, Bhardwaj, P, Bhaskar, S, Bibi, S, Bijani, A, Bodolica, V, Gupta, V, and Islam, Shariful

Published
2021

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

Author

Micah, AE, Su, Y, Bachmeier, SD, Chapin, A, Cogswell, IE, Crosby, SW, Cunningham, B, Harle, AC, Maddison, ER, Moitra, M, Sahu, M, Schneider, MT, Simpson, KE, Stutzman, HN, Tsakalos, G, Zende, RR, Zlavog, BS, Abbafati, C, Abebo, ZH, Abolhassani, H, Abrigo, MRM, Ahmed, MB, Akinyemi, RO, Alam, K, Ali, S, Alinia, C, Alipour, V, Aljunid, SM, Almasi, A, Alvis-Guzman, N, Ancuceanu, R, Andrei, T, Andrei, CL, Anjomshoa, M, Antonio, CAT, Arabloo, J, Arab-Zozani, M, Aremu, O, Atnafu, DD, Ausloos, M, Avila-Burgos, L, Ayanore, MA, Azari, S, Babalola, TK, Bagherzadeh, M, Baig, AA, Bakhtiari, A, Banach, M, Banerjee, SK, Barnighausen, TW, Basu, S, Baune, BT, Bayati, M, Berman, AE, Bhageerathy, R, Bhardwaj, P, Bohluli, M, Busse, R, Cahuana-Hurtado, L, Camera, LLAA, Castaneda-Orjuela, CA, Catala-Lopez, F, Cevik, M, Chattu, VK, Dandona, L, Dandona, R, Dianatinasab, M, Hoa, TD, Doshmangir, L, El Tantawi, M, Eskandarieh, S, Esmaeilzadeh, F, Faraj, A, Farzadfar, F, Fischer, F, Foigt, NA, Fullman, N, Gad, MM, Ghafourifard, M, Ghashghaee, A, Gholamian, A, Goharinezhad, S, Grada, A, Bidgoli, HH, Hamidi, S, Harb, HL, Hasanpoor, E, Hay, SI, Hendrie, D, Henry, NJ, Herteliu, C, Hole, MK, Hosseinzadeh, M, Hostiuc, S, Huda, TM, Humayun, A, Hwang, B-F, Ilesanmi, OS, Iqbal, U, Irvani, SS, Islam, SMS, Islam, MM, Jahani, MA, Jakovljevic, M, James, SL, Javaheri, Z, Jonas, JB, Joukar, F, Jozwiak, JJ, Jurisson, M, Kalhor, R, Matin, BK, Karimi, SE, Kayode, GA, Karyani, AK, Kinfu, Y, Kisa, A, Kohler, S, Komaki, H, Kosen, S, Kotlo, A, Koyanagi, A, Kumar, GA, Kusuma, D, Lansingh, VC, Larsson, AO, Lasrado, S, Lee, SWH, Lim, L-L, Lozano, R, Abd El Razek, HM, Mahdavi, MM, Maleki, S, Malekzadeh, R, Mansour-Ghanaei, F, Mansournia, MA, Mantovani, LG, Martinez, G, Masoumi, SZ, Massenburg, BB, Menezes, RG, Mengesha, EW, Meretoja, TJ, Meretoja, A, Mestrovic, T, Kostova, NM, Miller, TR, Mirica, A, Mirrakhimov, EM, Moghadaszadeh, M, Mohajer, B, Mohamadi, E, Darwesh, AM, Mohammadian-Hafshejani, A, Mohammadpourhodki, R, Mohammed, S, Mohebi, F, Mokdad, AH, Morrison, SD, Mosser, JF, Mousavi, SM, Muriithi, MK, Muthupandian, S, Myint, C-Y, Naderi, M, Nagarajan, AJ, Cuong, TN, Huong, LTN, Nonvignon, J, Noubiap, JJ, Oh, I-H, Olagunju, AT, Olusanya, JO, Olusanya, BO, Bali, AO, Onwujekwe, OE, Otstavnov, SS, Otstavnov, N, Owolabi, MO, Padubidri, JR, Palladino, R, Panda-Jonas, S, Pandey, A, Postma, MJ, Prada, SI, Pribadi, DRA, Rabiee, M, Rabiee, N, Rahim, F, Ranabhat, CL, Rao, SJ, Rathi, P, Rawaf, S, Rawaf, DL, Rawal, L, Rawassizadeh, R, Rezapour, A, Sabour, S, Sahraian, MA, Salman, OM, Salomon, JA, Samy, AM, Sanabria, J, Santos, JV, Milicevic, MMS, Jose, BPS, Savic, M, Schwendicke, F, Senthilkumaran, S, Sepanlou, SG, Servan-Mori, E, Setayesh, H, Shaikh, MA, Sheikh, A, Shibuya, K, Shrime, MG, Simonetti, B, Singh, JA, Singh, P, Skryabin, VY, Soheili, A, Soltani, S, Stefan, SC, Tabares-Seisdedos, R, Topor-Madry, R, Tovani-Palone, MR, Tran, BX, Travillian, R, Undurraga, EA, Valdez, PR, van Boven, JFM, Vasankari, TJ, Violante, FS, Vlassov, V, Vos, T, Wolfe, CDA, Wu, J, Yaya, S, Yazdi-Feyzabadi, V, Yip, P, Yonemoto, N, Younis, MZ, Yu, C, Zaidi, Z, Bin Zaman, S, Zastrozhin, MS, Zhang, Z-J, Zhao, Y, Murray, CJL, Dieleman, JL, Micah, AE, Su, Y, Bachmeier, SD, Chapin, A, Cogswell, IE, Crosby, SW, Cunningham, B, Harle, AC, Maddison, ER, Moitra, M, Sahu, M, Schneider, MT, Simpson, KE, Stutzman, HN, Tsakalos, G, Zende, RR, Zlavog, BS, Abbafati, C, Abebo, ZH, Abolhassani, H, Abrigo, MRM, Ahmed, MB, Akinyemi, RO, Alam, K, Ali, S, Alinia, C, Alipour, V, Aljunid, SM, Almasi, A, Alvis-Guzman, N, Ancuceanu, R, Andrei, T, Andrei, CL, Anjomshoa, M, Antonio, CAT, Arabloo, J, Arab-Zozani, M, Aremu, O, Atnafu, DD, Ausloos, M, Avila-Burgos, L, Ayanore, MA, Azari, S, Babalola, TK, Bagherzadeh, M, Baig, AA, Bakhtiari, A, Banach, M, Banerjee, SK, Barnighausen, TW, Basu, S, Baune, BT, Bayati, M, Berman, AE, Bhageerathy, R, Bhardwaj, P, Bohluli, M, Busse, R, Cahuana-Hurtado, L, Camera, LLAA, Castaneda-Orjuela, CA, Catala-Lopez, F, Cevik, M, Chattu, VK, Dandona, L, Dandona, R, Dianatinasab, M, Hoa, TD, Doshmangir, L, El Tantawi, M, Eskandarieh, S, Esmaeilzadeh, F, Faraj, A, Farzadfar, F, Fischer, F, Foigt, NA, Fullman, N, Gad, MM, Ghafourifard, M, Ghashghaee, A, Gholamian, A, Goharinezhad, S, Grada, A, Bidgoli, HH, Hamidi, S, Harb, HL, Hasanpoor, E, Hay, SI, Hendrie, D, Henry, NJ, Herteliu, C, Hole, MK, Hosseinzadeh, M, Hostiuc, S, Huda, TM, Humayun, A, Hwang, B-F, Ilesanmi, OS, Iqbal, U, Irvani, SS, Islam, SMS, Islam, MM, Jahani, MA, Jakovljevic, M, James, SL, Javaheri, Z, Jonas, JB, Joukar, F, Jozwiak, JJ, Jurisson, M, Kalhor, R, Matin, BK, Karimi, SE, Kayode, GA, Karyani, AK, Kinfu, Y, Kisa, A, Kohler, S, Komaki, H, Kosen, S, Kotlo, A, Koyanagi, A, Kumar, GA, Kusuma, D, Lansingh, VC, Larsson, AO, Lasrado, S, Lee, SWH, Lim, L-L, Lozano, R, Abd El Razek, HM, Mahdavi, MM, Maleki, S, Malekzadeh, R, Mansour-Ghanaei, F, Mansournia, MA, Mantovani, LG, Martinez, G, Masoumi, SZ, Massenburg, BB, Menezes, RG, Mengesha, EW, Meretoja, TJ, Meretoja, A, Mestrovic, T, Kostova, NM, Miller, TR, Mirica, A, Mirrakhimov, EM, Moghadaszadeh, M, Mohajer, B, Mohamadi, E, Darwesh, AM, Mohammadian-Hafshejani, A, Mohammadpourhodki, R, Mohammed, S, Mohebi, F, Mokdad, AH, Morrison, SD, Mosser, JF, Mousavi, SM, Muriithi, MK, Muthupandian, S, Myint, C-Y, Naderi, M, Nagarajan, AJ, Cuong, TN, Huong, LTN, Nonvignon, J, Noubiap, JJ, Oh, I-H, Olagunju, AT, Olusanya, JO, Olusanya, BO, Bali, AO, Onwujekwe, OE, Otstavnov, SS, Otstavnov, N, Owolabi, MO, Padubidri, JR, Palladino, R, Panda-Jonas, S, Pandey, A, Postma, MJ, Prada, SI, Pribadi, DRA, Rabiee, M, Rabiee, N, Rahim, F, Ranabhat, CL, Rao, SJ, Rathi, P, Rawaf, S, Rawaf, DL, Rawal, L, Rawassizadeh, R, Rezapour, A, Sabour, S, Sahraian, MA, Salman, OM, Salomon, JA, Samy, AM, Sanabria, J, Santos, JV, Milicevic, MMS, Jose, BPS, Savic, M, Schwendicke, F, Senthilkumaran, S, Sepanlou, SG, Servan-Mori, E, Setayesh, H, Shaikh, MA, Sheikh, A, Shibuya, K, Shrime, MG, Simonetti, B, Singh, JA, Singh, P, Skryabin, VY, Soheili, A, Soltani, S, Stefan, SC, Tabares-Seisdedos, R, Topor-Madry, R, Tovani-Palone, MR, Tran, BX, Travillian, R, Undurraga, EA, Valdez, PR, van Boven, JFM, Vasankari, TJ, Violante, FS, Vlassov, V, Vos, T, Wolfe, CDA, Wu, J, Yaya, S, Yazdi-Feyzabadi, V, Yip, P, Yonemoto, N, Younis, MZ, Yu, C, Zaidi, Z, Bin Zaman, S, Zastrozhin, MS, Zhang, Z-J, Zhao, Y, Murray, CJL, and Dieleman, JL

Abstract

BACKGROUND: 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. METHODS: 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. FINDINGS: 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

Published
2020

3. Estimating total spending by source of funding on routine and supplementary immunisation activities in low-income and middle-income countries, 2000-17: a financial modelling study.

Author

Ikilezi G, Micah AE, Bachmeier SD, Cogswell IE, Maddison ER, Stutzman HN, Tsakalos G, Brenzel L, and Dieleman JL

Subjects
Child, Child, Preschool, Developing Countries statistics & numerical data, Financing, Government economics, Health Expenditures, Healthcare Financing, Humans, Immunization statistics & numerical data, Immunization Programs economics, Infant, International Agencies economics, Vaccines economics, Developing Countries economics, Immunization economics
Abstract

Background: Childhood immunisation is one of the most cost-effective health interventions. However, despite its known value, global access to vaccines remains far from complete. Although supply-side constraints lead to inadequate vaccine coverage in many health systems, there is no comprehensive analysis of the funding for immunisation. We aimed to fill this gap by generating estimates of funding for immunisation disaggregated by the source of funding and the type of activities in order to highlight the funding landscape for immunisation and inform policy making., Methods: For this financial modelling study, we estimated annual spending on immunisations for 135 low-income and middle-income countries (as determined by the World Bank) from 2000 to 2017, with a focus on government, donor, and out-of-pocket spending, and disaggregated spending for vaccines and delivery costs, and routine schedules and supplementary campaigns. To generate these estimates, we extracted data from National Health Accounts, the WHO-UNICEF Joint Reporting Forms, comprehensive multi-year plans, databases from Gavi, the Vaccine Alliance, and the Institute for Health Metrics and Evaluation's 2019 development assistance for health database. We estimated total spending on immunisation by aggregating the government, donor, prepaid private, and household spending estimates., Findings: Between 2000 and 2017, funding for immunisation totalled US$112·4 billion (95% uncertainty interval 108·5-118·5). Aggregated across all low-income and middle-income countries, government spending consistently remained the largest source of funding, providing between 60·0% (57·7-61·9) and 79·3% (73·8-81·4) of total immunisation spending each year (corresponding to between $2·5 billion [2·3-2·8] and $6·4 billion [6·0-7·0] each year). Across income groups, immunisation spending per surviving infant was similar in low-income and lower-middle-income countries and territories, with average spending of $40 (38-42) in low-income countries and $42 (39-46) in lower-middle-income countries, in 2017. In low-income countries and territories, development assistance made up the largest share of total immunisation spending (69·4% [64·6-72·0]; $630·2 million) in 2017. Across the 135 countries, we observed higher vaccine coverage and increased government spending on immunisation over time, although in some countries, predominantly in Latin America and the Caribbean and in sub-Saharan Africa, vaccine coverage decreased over time, while spending increased., Interpretation: These estimates highlight the progress over the past two decades in increasing spending on immunisation. However, many challenges still remain and will require dedication and commitment to ensure that the progress made in the previous decade is sustained and advanced in the next decade for the Immunization Agenda 2030., Funding: Bill & Melinda Gates Foundation., Competing Interests: Declaration of interests We declare no competing interests., (Copyright © 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.)

Published
2021
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4. Tracking government spending on immunization: The joint reporting forms, national health accounts, comprehensive multi-year plans and co-financing data.

Author

Ikilezi G, Bachmeier SD, Cogswell IE, Maddison ER, Stutzman HN, Tsakalos G, Brenzel L, Dieleman JL, and Micah AE

Subjects
Developing Countries, Financing, Government, Government, Humans, Immunization, Immunization Programs, SARS-CoV-2, COVID-19, Pandemics
Abstract

Background: Coverage rates for immunization have dropped in lower income countries during the COVID-19 pandemic, raising concerns regarding potential outbreaks and premature death. In order to re-invigorate immunization service delivery, sufficient financing must be made available from all sources, and particularly from government resources. This study utilizes the most recent data available to provide an updated comparison of available data sources on government spending on immunization., Methods: We examined data from WHO/UNICEF's Joint Reporting Form (JRF), country Comprehensive Multi-Year Plan (cMYP), country co-financing data for Gavi, and WHO National Health Accounts (NHA) on government spending on immunization for consistency by comparing routine and vaccine spending where both values were reported. We also examined spending trends across time, quantified underreporting and utilized concordance analyses to assess the magnitude of difference between the data sources., Results: Routine immunization spending reported through the cMYP was nearly double that reported through the JRF (rho = 0.64, 95% 0.53 to 0.77) and almost four times higher than that reported through the NHA on average (rho = 3.71, 95% 1.00 to 13.87). Routine immunization spending from the JRF was comparable to spending reported in the NHA (rho = 1.30, 95% 0.97 to 1.75) and vaccine spending from the JRF was comparable to that from the cMYP data (rho = 0.97, 95% 0.84 to 1.12). Vaccine spending from both the JRF and cMYP was higher than Gavi co-financing by a at least two (rho = 2.66, 95% 2.45 to 2.89) and (rho = 2.66, 95% 2.15 to 3.30), respectively., Implications: Overall, our comparative analysis provides a degree of confidence in the validity of existing reporting mechanisms for immunization spending while highlighting areas for potential improvements. Users of these data sources should factor these into consideration when utilizing the data. Additionally, partners should work with governments to encourage more reliable, comprehensive, and accurate reporting of vaccine and immunization spending., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2021 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Published
2021
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