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1. Global investments in pandemic preparedness and COVID-19: development assistance and domestic spending on health between 1990 and 2026

Author: Micah, A, Bhangdia, K, Cogswell, I, Lasher, D, Lidral-Porter, B, Maddison, E, Nguyen, T, Patel, N, Pedroza, P, Solorio, J, Stutzman, H, Tsakalos, G, Wang, Y, Warriner, W, Zhao, Y, Zlavog, B, Abbafati, C, Abbas, J, Abbasi-Kangevari, M, Abbasi-Kangevari, Z, Abdelmasseh, M, Abdulah, D, Abedi, A, Abegaz, K, Abhilash, E, Aboagye, R, Abolhassani, H, Abrigo, M, Abubaker Ali, H, Abu-Gharbieh, E, Adem, M, Afzal, M, Ahmadi, A, Ahmed, H, Ahmed Rashid, T, Aji, B, Akbarialiabad, H, Akelew, Y, Al Hamad, H, Alam, K, Alanezi, F, Alanzi, T, Al-Hanawi, M, Alhassan, R, Aljunid, S, Almustanyir, S, Al-Raddadi, R, Alvis-Guzman, N, Alvis-Zakzuk, N, Amare, A, Ameyaw, E, Amini-Rarani, M, Amu, H, Ancuceanu, R, Andrei, T, Anwar, S, Appiah, F, Aqeel, M, Arabloo, J, Arab-Zozani, M, Aravkin, A, Aremu, O, Aruleba, R, Athari, S, Avila-Burgos, L, Ayanore, M, Azari, S, Baig, A, Bantie, A, Barrow, A, Baskaran, P, Basu, S, Batiha, A, Baune, B, Berezvai, Z, Bhardwaj, N, Bhardwaj, P, Bhaskar, S, Boachie, M, Bodolica, V, Botelho, J, Braithwaite, D, Breitborde, N, Busse, R, Cahuana-Hurtado, L, Catala-Lopez, F, Chansa, C, Charan, J, Chattu, V, Chen, S, Chukwu, I, Dadras, O, Dandona, L, Dandona, R, Dargahi, A, Debela, S, Denova-Gutierrez, E, Desye, B, Dharmaratne, S, Diao, N, Doan, L, Dodangeh, M, dos Santos, W, Doshmangir, L, Dube, J, Eini, E, El Sayed Zaki, M, El Tantawi, M, Enyew, D, Eskandarieh, S, Ezati Asar, M, Fagbamigbe, A, Faraon, E, Fatehizadeh, A, Fattahi, H, Fekadu, G, Fischer, F, Foigt, N, Fowobaje, K, Freitas, A, Fukumoto, T, Fullman, N, Gaal, P, Gamkrelidze, A, Garcia-Gordillo, M, Gebrehiwot, M, Gerema, U, Ghafourifard, M, Ghamari, S, Ghanbari, R, Ghashghaee, A, Gholamrezanezhad, A, Golechha, M, Golinelli, D, Goshu, Y, Goyomsa, G, Guha, A, Gunawardane, D, Gupta, B, Hamidi, S, Harapan, H, Hashempour, R, Hayat, K, Heidari, G, Heredia-Pi, I, Herteliu, C, Heyi, D, Hezam, K, Hiraike, Y, Hlongwa, M, Holla, R, Hoque, M, Hosseinzadeh, M, Hostiuc, S, Hussain, S, Ilesanmi, O, Immurana, M, Iradukunda, A, Ismail, N, Isola, G, J, L, Jakovljevic, M, Jalili, M, Janodia, M, Javaheri, T, Jayapal, S, Jemere, D, Joo, T, Joseph, N, Jozwiak, J, Jurisson, M, Kaambwa, B, Kadashetti, V, Kadel, R, Kadir, D, Kalankesh, L, Kamath, R, Kandel, H, Kantar, R, Karanth, S, Karaye, I, Karimi, S, Kassa, B, Kayode, G, Keikavoosi-Arani, L, Keshri, V, Keskin, C, Khader, Y, Khafaie, M, Khajuria, H, Khayat Kashani, H, Kifle, Z, Kim, H, Kim, J, Kim, M, Kim, Y, Kisa, A, Kohler, S, Kompani, F, Kosen, S, Koulmane Laxminarayana, S, Koyanagi, A, Krishan, K, Kusuma, D, Lam, J, Lamnisos, D, Larsson, A, Lee, S, Lee, W, Lee, Y, Lenzi, J, Lim, L, Lorenzovici, L, Lozano, R, Machado, V, Madadizadeh, F, Magdy Abd El Razek, M, Mahmoudi, R, Majeed, A, Malekpour, M, Manda, A, Mansouri, B, Mansournia, M, Mantovani, L, Marrugo Arnedo, C, Martorell, M, Masoud, A, Mathews, E, Maude, R, Mechili, E, Mehrabi Nasab, E, Mendes, J, Meretoja, A, Meretoja, T, Mesregah, M, Mestrovic, T, Mirica, A, Mirrakhimov, E, Mirutse, M, Mirza, M, Mirza-Aghazadeh-Attari, M, Misganaw, A, Moccia, M, Moghadasi, J, Mohammadi, E, Mohammadi, M, Mohammadian-Hafshejani, A, Mohammadshahi, M, Mohammed, S, Mohseni, M, Mokdad, A, Monasta, L, Mossialos, E, Mostafavi, E, Mousavi Isfahani, H, Mpundu-Kaambwa, C, Murthy, S, Muthupandian, S, Nagarajan, A, Naidoo, K, Naimzada, M, Nangia, V, Naqvi, A, Nayak, B, Ndejjo, R, Noroozi, N, Noubiap, J, Nuruzzaman, K, Nzoputam, C, Nzoputam, O, Oancea, B, Obi, F, Ogunkoya, A, Oh, I, Okonji, O, Olagunju, A, Olagunju, T, Olakunde, B, Omar Bali, A, Onwujekwe, O, Opio, J, Otoiu, A, Otstavnov, N, Otstavnov, S, Owolabi, M, Palicz, T, Palladino, R, Pana, A, Parekh, T, Pasupula, D, Patel, J, Patton, G, Paudel, U, Paun, M, Pawar, S, Perna, S, Perumalsamy, N, Petcu, I, Piracha, Z, Poursadeqiyan, M, Pourtaheri, N, Prada, S, Rafiei, S, Raghav, P, Rahim, F, Rahman, M, Rahmani, A, Ranabhat, C, Raru, T, Rashedi, S, Rashidi, M, Ravangard, R, Rawaf, S, Rawassizadeh, R, Redwan, E, Reiner, R, Renzaho, A, Rezaei, M, Rezaei, N, Riaz, M, Rodriguez, J, Saad, A, Saddik, B, Sadeghian, S, Saeb, M, Saeed, U, Sahu, M, Saki, M, Salamati, P, Salari, H, Salehi, S, Samy, A, Sanabria, J, Sanmarchi, F, Santos, J, Santric-Milicevic, M, Sao Jose, B, Sarikhani, Y, Sathian, B, Satpathy, M, Savic, M, Sayadi, Y, Schwendicke, F, Senthilkumaran, S, Sepanlou, S, Servan-Mori, E, Setshegetso, N, Seylani, A, Shahabi, S, Shaikh, M, Shakhmardanov, M, Shanawaz, M, Sharew, M, Sharew, N, Sharma, R, Shayan, M, Sheikh, A, Shenoy, S, Shetty, A, Shetty, P, Shivakumar, K, Silva, L, Simegn, W, Singh, J, Singh, K, Skhvitaridze, N, Skryabin, V, Skryabina, A, Socea, B, Solomon, Y, Song, S, Stefan, S, Suleman, M, Tabares-Seisdedos, R, Tat, N, Tat, V, Tefera, B, Tichopad, A, Tobe-Gai, R, Tovani-Palone, M, Tudor Car, L, Tufa, D, Vasankari, T, Vasic, M, Vervoort, D, Vlassov, V, Vo, B, Vu, L, Waheed, Y, Wamai, R, Wang, C, Wassie, G, Wickramasinghe, N, Yaya, S, Yigit, A, Yigit, V, Yonemoto, N, Younis, M, Yu, C, Yunusa, I, Zaki, L, Zaman, B, Zangeneh, A, Zare Dehnavi, A, Zastrozhin, M, Zeng, W, Zhang, Z, Zuhlke, L, Zuniga, Y, Hay, S, Murray, C, Dieleman, J, Micah A. E., Bhangdia K., Cogswell I. E., Lasher D., Lidral-Porter B., Maddison E. R., Nguyen T. N. N., Patel N., Pedroza P., Solorio J., Stutzman H., Tsakalos G., Wang Y., Warriner W., Zhao Y., Zlavog B. S., Abbafati C., Abbas J., Abbasi-Kangevari M., Abbasi-Kangevari Z., Abdelmasseh M., Abdulah D. M., Abedi A., Abegaz K. H., Abhilash E. S., Aboagye R. G., Abolhassani H., Abrigo M. R. M., Abubaker Ali H., Abu-Gharbieh E., Adem M. H., Afzal M. S., Ahmadi A., Ahmed H., Ahmed Rashid T., Aji B., Akbarialiabad H., Akelew Y., Al Hamad H., Alam K., Alanezi F. M., Alanzi T. M., Al-Hanawi M. K., Alhassan R. K., Aljunid S. M., Almustanyir S., Al-Raddadi R. M., Alvis-Guzman N., Alvis-Zakzuk N. J., Amare A. T., Ameyaw E. K., Amini-Rarani M., Amu H., Ancuceanu R., Andrei T., Anwar S. L., Appiah F., Aqeel M., Arabloo J., Arab-Zozani M., Aravkin A. Y., Aremu O., Aruleba R. T., Athari S. S., Avila-Burgos L., Ayanore M. A., Azari S., Baig A. A., Bantie A. T., Barrow A., Baskaran P., Basu S., Batiha A. -M. M., Baune B. T., Berezvai Z., Bhardwaj N., Bhardwaj P., Bhaskar S., Boachie M. K., Bodolica V., Botelho J. S. B., Braithwaite D., Breitborde N. J. K., Busse R., Cahuana-Hurtado L., Catala-Lopez F., Chansa C., Charan J., Chattu V. K., Chen S., Chukwu I. S., Dadras O., Dandona L., Dandona R., Dargahi A., Debela S. A., Denova-Gutierrez E., Desye B., Dharmaratne S. D., Diao N., Doan L. P., Dodangeh M., dos Santos W. M., Doshmangir L., Dube J., Eini E., El Sayed Zaki M., El Tantawi M., Enyew D. B., Eskandarieh S., Ezati Asar M., Fagbamigbe A. F., Faraon E. J. A., Fatehizadeh A., Fattahi H., Fekadu G., Fischer F., Foigt N. A., Fowobaje K. R., Freitas A., Fukumoto T., Fullman N., Gaal P. A., Gamkrelidze A., Garcia-Gordillo M. A., Gebrehiwot M., Gerema U., Ghafourifard M., Ghamari S. -H., Ghanbari R., Ghashghaee A., Gholamrezanezhad A., Golechha M., Golinelli D., Goshu Y. A., Goyomsa G. G., Guha A., Gunawardane D. A., Gupta B., Hamidi S., Harapan H., Hashempour R., Hayat K., Heidari G., Heredia-Pi I., Herteliu C., Heyi D. Z., Hezam K., Hiraike Y., Hlongwa M. M., Holla R., Hoque M. E., Hosseinzadeh M., Hostiuc S., Hussain S., Ilesanmi O. S., Immurana M., Iradukunda A., Ismail N. E., Isola G., J L. M., Jakovljevic M., Jalili M., Janodia M. D., Javaheri T., Jayapal S. K., Jemere D. M., Joo T., Joseph N., Jozwiak J. J., Jurisson M., Kaambwa B., Kadashetti V., Kadel R., Kadir D. H., Kalankesh L. R., Kamath R., Kandel H., Kantar R. S., Karanth S. D., Karaye I. M., Karimi S. E., Kassa B. G., Kayode G. A., Keikavoosi-Arani L., Keshri V. R., Keskin C., Khader Y. S., Khafaie M. A., Khajuria H., Khayat Kashani H. R., Kifle Z. D., Kim H., Kim J., Kim M. S., Kim Y. J., Kisa A., Kohler S., Kompani F., Kosen S., Koulmane Laxminarayana S. L., Koyanagi A., Krishan K., Kusuma D., Lam J., Lamnisos D., Larsson A. O., Lee S. -W., Lee S. W. H., Lee W. -C., Lee Y. H., Lenzi J., Lim L. -L., Lorenzovici L., Lozano R., Machado V. S. M., Madadizadeh F., Magdy Abd El Razek M., Mahmoudi R., Majeed A., Malekpour M. -R., Manda A. L., Mansouri B., Mansournia M. A., Mantovani L. G., Marrugo Arnedo C. A., Martorell M., Masoud A., Mathews E., Maude R. J., Mechili E. A., Mehrabi Nasab E., Mendes J. J. J. M., Meretoja A., Meretoja T. J., Mesregah M. K., Mestrovic T., Mirica A., Mirrakhimov E. M., Mirutse M. K., Mirza M., Mirza-Aghazadeh-Attari M., Misganaw A., Moccia M., Moghadasi J., Mohammadi E., Mohammadi M., Mohammadian-Hafshejani A., Mohammadshahi M., Mohammed S., Mohseni M., Mokdad A. H., Monasta L., Mossialos E., Mostafavi E., Mousavi Isfahani H., Mpundu-Kaambwa C., Murthy S., Muthupandian S., Nagarajan A. J., Naidoo K. S., Naimzada M. D., Nangia V., Naqvi A. A., Nayak B. P., Ndejjo R., Nguyen T. H., Noroozi N., Noubiap J. J., Nuruzzaman K. M., Nzoputam C. I., Nzoputam O. J., Oancea B., Obi F. C. A., Ogunkoya A., Oh I. -H., Okonji O. C., Olagunju A. T., Olagunju T. O., Olakunde B. O., Omar Bali A., Onwujekwe O. E., Opio J. N., Otoiu A., Otstavnov N., Otstavnov S. S., Owolabi M. O., Palicz T., Palladino R., Pana A., Parekh T., Pasupula D. K., Patel J., Patton G. C., Paudel U., Paun M., Pawar S., Perna S., Perumalsamy N., Petcu I. -R., Piracha Z. Z., Poursadeqiyan M., Pourtaheri N., Prada S. I., Rafiei S., Raghav P. R., Rahim F., Rahman M. H. U., Rahman M., Rahmani A. M., Ranabhat C. L., Raru T. B., Rashedi S., Rashidi M. -M., Ravangard R., Rawaf S., Rawassizadeh R., Redwan E. M. M., Reiner R. C., Renzaho A. M. N., Rezaei M., Rezaei N., Riaz M. A., Rodriguez J. A. B., Saad A. M. A., Saddik B., Sadeghian S., Saeb M. R., Saeed U., Sahu M., Saki M., Salamati P., Salari H., Salehi S., Samy A. M., Sanabria J., Sanmarchi F., Santos J. V., Santric-Milicevic M. M., Sao Jose B. P., Sarikhani Y., Sathian B., Satpathy M., Savic M., Sayadi Y., Schwendicke F., Senthilkumaran S., Sepanlou S. G., Servan-Mori E., Setshegetso N., Seylani A., Shahabi S., Shaikh M. A., Shakhmardanov M. Z., Shanawaz M., Sharew M. M. S., Sharew N. T., Sharma R., Shayan M., Sheikh A., Shenoy S. M., Shetty A., Shetty P. H., Shivakumar K. M., Silva L. M. L. R., Simegn W., Singh J. A., Singh K., Skhvitaridze N., Skryabin V. Y., Skryabina A. A., Socea B., Solomon Y., Song S., Stefan S. C., Suleman M., Tabares-Seisdedos R., Tat N. Y., Tat V. Y., Tefera B. N., Tichopad A., Tobe-Gai R., Tovani-Palone M. R., Tudor Car L., Tufa D. G., Vasankari T. J., Vasic M., Vervoort D., Vlassov V., Vo B., Vu L. G., Waheed Y., Wamai R. G., Wang C., Wassie G. T., Wickramasinghe N. D., Yaya S., Yigit A., Yigit V., Yonemoto N., Younis M. Z., Yu C., Yunusa I., Zaki L., Zaman B. A., Zangeneh A., Zare Dehnavi A., Zastrozhin M. S., Zeng W., Zhang Z. -J., Zuhlke L. J., Zuniga Y. M. H., Hay S. I., Murray C. J. L., Dieleman J. L., Micah, A, Bhangdia, K, Cogswell, I, Lasher, D, Lidral-Porter, B, Maddison, E, Nguyen, T, Patel, N, Pedroza, P, Solorio, J, Stutzman, H, Tsakalos, G, Wang, Y, Warriner, W, Zhao, Y, Zlavog, B, Abbafati, C, Abbas, J, Abbasi-Kangevari, M, Abbasi-Kangevari, Z, Abdelmasseh, M, Abdulah, D, Abedi, A, Abegaz, K, Abhilash, E, Aboagye, R, Abolhassani, H, Abrigo, M, Abubaker Ali, H, Abu-Gharbieh, E, Adem, M, Afzal, M, Ahmadi, A, Ahmed, H, Ahmed Rashid, T, Aji, B, Akbarialiabad, H, Akelew, Y, Al Hamad, H, Alam, K, Alanezi, F, Alanzi, T, Al-Hanawi, M, Alhassan, R, Aljunid, S, Almustanyir, S, Al-Raddadi, R, Alvis-Guzman, N, Alvis-Zakzuk, N, Amare, A, Ameyaw, E, Amini-Rarani, M, Amu, H, Ancuceanu, R, Andrei, T, Anwar, S, Appiah, F, Aqeel, M, Arabloo, J, Arab-Zozani, M, Aravkin, A, Aremu, O, Aruleba, R, Athari, S, Avila-Burgos, L, Ayanore, M, Azari, S, Baig, A, Bantie, A, Barrow, A, Baskaran, P, Basu, S, Batiha, A, Baune, B, Berezvai, Z, Bhardwaj, N, Bhardwaj, P, Bhaskar, S, Boachie, M, Bodolica, V, Botelho, J, Braithwaite, D, Breitborde, N, Busse, R, Cahuana-Hurtado, L, Catala-Lopez, F, Chansa, C, Charan, J, Chattu, V, Chen, S, Chukwu, I, Dadras, O, Dandona, L, Dandona, R, Dargahi, A, Debela, S, Denova-Gutierrez, E, Desye, B, Dharmaratne, S, Diao, N, Doan, L, Dodangeh, M, dos Santos, W, Doshmangir, L, Dube, J, Eini, E, El Sayed Zaki, M, El Tantawi, M, Enyew, D, Eskandarieh, S, Ezati Asar, M, Fagbamigbe, A, Faraon, E, Fatehizadeh, A, Fattahi, H, Fekadu, G, Fischer, F, Foigt, N, Fowobaje, K, Freitas, A, Fukumoto, T, Fullman, N, Gaal, P, Gamkrelidze, A, Garcia-Gordillo, M, Gebrehiwot, M, Gerema, U, Ghafourifard, M, Ghamari, S, Ghanbari, R, Ghashghaee, A, Gholamrezanezhad, A, Golechha, M, Golinelli, D, Goshu, Y, Goyomsa, G, Guha, A, Gunawardane, D, Gupta, B, Hamidi, S, Harapan, H, Hashempour, R, Hayat, K, Heidari, G, Heredia-Pi, I, Herteliu, C, Heyi, D, Hezam, K, Hiraike, Y, Hlongwa, M, Holla, R, Hoque, M, Hosseinzadeh, M, Hostiuc, S, Hussain, S, Ilesanmi, O, Immurana, M, Iradukunda, A, Ismail, N, Isola, G, J, L, Jakovljevic, M, Jalili, M, Janodia, M, Javaheri, T, Jayapal, S, Jemere, D, Joo, T, Joseph, N, Jozwiak, J, Jurisson, M, Kaambwa, B, Kadashetti, V, Kadel, R, Kadir, D, Kalankesh, L, Kamath, R, Kandel, H, Kantar, R, Karanth, S, Karaye, I, Karimi, S, Kassa, B, Kayode, G, Keikavoosi-Arani, L, Keshri, V, Keskin, C, Khader, Y, Khafaie, M, Khajuria, H, Khayat Kashani, H, Kifle, Z, Kim, H, Kim, J, Kim, M, Kim, Y, Kisa, A, Kohler, S, Kompani, F, Kosen, S, Koulmane Laxminarayana, S, Koyanagi, A, Krishan, K, Kusuma, D, Lam, J, Lamnisos, D, Larsson, A, Lee, S, Lee, W, Lee, Y, Lenzi, J, Lim, L, Lorenzovici, L, Lozano, R, Machado, V, Madadizadeh, F, Magdy Abd El Razek, M, Mahmoudi, R, Majeed, A, Malekpour, M, Manda, A, Mansouri, B, Mansournia, M, Mantovani, L, Marrugo Arnedo, C, Martorell, M, Masoud, A, Mathews, E, Maude, R, Mechili, E, Mehrabi Nasab, E, Mendes, J, Meretoja, A, Meretoja, T, Mesregah, M, Mestrovic, T, Mirica, A, Mirrakhimov, E, Mirutse, M, Mirza, M, Mirza-Aghazadeh-Attari, M, Misganaw, A, Moccia, M, Moghadasi, J, Mohammadi, E, Mohammadi, M, Mohammadian-Hafshejani, A, Mohammadshahi, M, Mohammed, S, Mohseni, M, Mokdad, A, Monasta, L, Mossialos, E, Mostafavi, E, Mousavi Isfahani, H, Mpundu-Kaambwa, C, Murthy, S, Muthupandian, S, Nagarajan, A, Naidoo, K, Naimzada, M, Nangia, V, Naqvi, A, Nayak, B, Ndejjo, R, Noroozi, N, Noubiap, J, Nuruzzaman, K, Nzoputam, C, Nzoputam, O, Oancea, B, Obi, F, Ogunkoya, A, Oh, I, Okonji, O, Olagunju, A, Olagunju, T, Olakunde, B, Omar Bali, A, Onwujekwe, O, Opio, J, Otoiu, A, Otstavnov, N, Otstavnov, S, Owolabi, M, Palicz, T, Palladino, R, Pana, A, Parekh, T, Pasupula, D, Patel, J, Patton, G, Paudel, U, Paun, M, Pawar, S, Perna, S, Perumalsamy, N, Petcu, I, Piracha, Z, Poursadeqiyan, M, Pourtaheri, N, Prada, S, Rafiei, S, Raghav, P, Rahim, F, Rahman, M, Rahmani, A, Ranabhat, C, Raru, T, Rashedi, S, Rashidi, M, Ravangard, R, Rawaf, S, Rawassizadeh, R, Redwan, E, Reiner, R, Renzaho, A, Rezaei, M, Rezaei, N, Riaz, M, Rodriguez, J, Saad, A, Saddik, B, Sadeghian, S, Saeb, M, Saeed, U, Sahu, M, Saki, M, Salamati, P, Salari, H, Salehi, S, Samy, A, Sanabria, J, Sanmarchi, F, Santos, J, Santric-Milicevic, M, Sao Jose, B, Sarikhani, Y, Sathian, B, Satpathy, M, Savic, M, Sayadi, Y, Schwendicke, F, Senthilkumaran, S, Sepanlou, S, Servan-Mori, E, Setshegetso, N, Seylani, A, Shahabi, S, Shaikh, M, Shakhmardanov, M, Shanawaz, M, Sharew, M, Sharew, N, Sharma, R, Shayan, M, Sheikh, A, Shenoy, S, Shetty, A, Shetty, P, Shivakumar, K, Silva, L, Simegn, W, Singh, J, Singh, K, Skhvitaridze, N, Skryabin, V, Skryabina, A, Socea, B, Solomon, Y, Song, S, Stefan, S, Suleman, M, Tabares-Seisdedos, R, Tat, N, Tat, V, Tefera, B, Tichopad, A, Tobe-Gai, R, Tovani-Palone, M, Tudor Car, L, Tufa, D, Vasankari, T, Vasic, M, Vervoort, D, Vlassov, V, Vo, B, Vu, L, Waheed, Y, Wamai, R, Wang, C, Wassie, G, Wickramasinghe, N, Yaya, S, Yigit, A, Yigit, V, Yonemoto, N, Younis, M, Yu, C, Yunusa, I, Zaki, L, Zaman, B, Zangeneh, A, Zare Dehnavi, A, Zastrozhin, M, Zeng, W, Zhang, Z, Zuhlke, L, Zuniga, Y, Hay, S, Murray, C, Dieleman, J, Micah A. E., Bhangdia K., Cogswell I. E., Lasher D., Lidral-Porter B., Maddison E. R., Nguyen T. N. N., Patel N., Pedroza P., Solorio J., Stutzman H., Tsakalos G., Wang Y., Warriner W., Zhao Y., Zlavog B. S., Abbafati C., Abbas J., Abbasi-Kangevari M., Abbasi-Kangevari Z., Abdelmasseh M., Abdulah D. M., Abedi A., Abegaz K. H., Abhilash E. S., Aboagye R. G., Abolhassani H., Abrigo M. R. M., Abubaker Ali H., Abu-Gharbieh E., Adem M. H., Afzal M. S., Ahmadi A., Ahmed H., Ahmed Rashid T., Aji B., Akbarialiabad H., Akelew Y., Al Hamad H., Alam K., Alanezi F. M., Alanzi T. M., Al-Hanawi M. K., Alhassan R. K., Aljunid S. M., Almustanyir S., Al-Raddadi R. M., Alvis-Guzman N., Alvis-Zakzuk N. J., Amare A. T., Ameyaw E. K., Amini-Rarani M., Amu H., Ancuceanu R., Andrei T., Anwar S. L., Appiah F., Aqeel M., Arabloo J., Arab-Zozani M., Aravkin A. Y., Aremu O., Aruleba R. T., Athari S. S., Avila-Burgos L., Ayanore M. A., Azari S., Baig A. A., Bantie A. T., Barrow A., Baskaran P., Basu S., Batiha A. -M. M., Baune B. T., Berezvai Z., Bhardwaj N., Bhardwaj P., Bhaskar S., Boachie M. K., Bodolica V., Botelho J. S. B., Braithwaite D., Breitborde N. J. K., Busse R., Cahuana-Hurtado L., Catala-Lopez F., Chansa C., Charan J., Chattu V. K., Chen S., Chukwu I. S., Dadras O., Dandona L., Dandona R., Dargahi A., Debela S. A., Denova-Gutierrez E., Desye B., Dharmaratne S. D., Diao N., Doan L. P., Dodangeh M., dos Santos W. M., Doshmangir L., Dube J., Eini E., El Sayed Zaki M., El Tantawi M., Enyew D. B., Eskandarieh S., Ezati Asar M., Fagbamigbe A. F., Faraon E. J. A., Fatehizadeh A., Fattahi H., Fekadu G., Fischer F., Foigt N. A., Fowobaje K. R., Freitas A., Fukumoto T., Fullman N., Gaal P. A., Gamkrelidze A., Garcia-Gordillo M. A., Gebrehiwot M., Gerema U., Ghafourifard M., Ghamari S. -H., Ghanbari R., Ghashghaee A., Gholamrezanezhad A., Golechha M., Golinelli D., Goshu Y. A., Goyomsa G. G., Guha A., Gunawardane D. A., Gupta B., Hamidi S., Harapan H., Hashempour R., Hayat K., Heidari G., Heredia-Pi I., Herteliu C., Heyi D. Z., Hezam K., Hiraike Y., Hlongwa M. M., Holla R., Hoque M. E., Hosseinzadeh M., Hostiuc S., Hussain S., Ilesanmi O. S., Immurana M., Iradukunda A., Ismail N. E., Isola G., J L. M., Jakovljevic M., Jalili M., Janodia M. D., Javaheri T., Jayapal S. K., Jemere D. M., Joo T., Joseph N., Jozwiak J. J., Jurisson M., Kaambwa B., Kadashetti V., Kadel R., Kadir D. H., Kalankesh L. R., Kamath R., Kandel H., Kantar R. S., Karanth S. D., Karaye I. M., Karimi S. E., Kassa B. G., Kayode G. A., Keikavoosi-Arani L., Keshri V. R., Keskin C., Khader Y. S., Khafaie M. A., Khajuria H., Khayat Kashani H. R., Kifle Z. D., Kim H., Kim J., Kim M. S., Kim Y. J., Kisa A., Kohler S., Kompani F., Kosen S., Koulmane Laxminarayana S. L., Koyanagi A., Krishan K., Kusuma D., Lam J., Lamnisos D., Larsson A. O., Lee S. -W., Lee S. W. H., Lee W. -C., Lee Y. H., Lenzi J., Lim L. -L., Lorenzovici L., Lozano R., Machado V. S. M., Madadizadeh F., Magdy Abd El Razek M., Mahmoudi R., Majeed A., Malekpour M. -R., Manda A. L., Mansouri B., Mansournia M. A., Mantovani L. G., Marrugo Arnedo C. A., Martorell M., Masoud A., Mathews E., Maude R. J., Mechili E. A., Mehrabi Nasab E., Mendes J. J. J. M., Meretoja A., Meretoja T. J., Mesregah M. K., Mestrovic T., Mirica A., Mirrakhimov E. M., Mirutse M. K., Mirza M., Mirza-Aghazadeh-Attari M., Misganaw A., Moccia M., Moghadasi J., Mohammadi E., Mohammadi M., Mohammadian-Hafshejani A., Mohammadshahi M., Mohammed S., Mohseni M., Mokdad A. H., Monasta L., Mossialos E., Mostafavi E., Mousavi Isfahani H., Mpundu-Kaambwa C., Murthy S., Muthupandian S., Nagarajan A. J., Naidoo K. S., Naimzada M. D., Nangia V., Naqvi A. A., Nayak B. P., Ndejjo R., Nguyen T. H., Noroozi N., Noubiap J. J., Nuruzzaman K. M., Nzoputam C. I., Nzoputam O. J., Oancea B., Obi F. C. A., Ogunkoya A., Oh I. -H., Okonji O. C., Olagunju A. T., Olagunju T. O., Olakunde B. O., Omar Bali A., Onwujekwe O. E., Opio J. N., Otoiu A., Otstavnov N., Otstavnov S. S., Owolabi M. O., Palicz T., Palladino R., Pana A., Parekh T., Pasupula D. K., Patel J., Patton G. C., Paudel U., Paun M., Pawar S., Perna S., Perumalsamy N., Petcu I. -R., Piracha Z. Z., Poursadeqiyan M., Pourtaheri N., Prada S. I., Rafiei S., Raghav P. R., Rahim F., Rahman M. H. U., Rahman M., Rahmani A. M., Ranabhat C. L., Raru T. B., Rashedi S., Rashidi M. -M., Ravangard R., Rawaf S., Rawassizadeh R., Redwan E. M. M., Reiner R. C., Renzaho A. M. N., Rezaei M., Rezaei N., Riaz M. A., Rodriguez J. A. B., Saad A. M. A., Saddik B., Sadeghian S., Saeb M. R., Saeed U., Sahu M., Saki M., Salamati P., Salari H., Salehi S., Samy A. M., Sanabria J., Sanmarchi F., Santos J. V., Santric-Milicevic M. M., Sao Jose B. P., Sarikhani Y., Sathian B., Satpathy M., Savic M., Sayadi Y., Schwendicke F., Senthilkumaran S., Sepanlou S. G., Servan-Mori E., Setshegetso N., Seylani A., Shahabi S., Shaikh M. A., Shakhmardanov M. Z., Shanawaz M., Sharew M. M. S., Sharew N. T., Sharma R., Shayan M., Sheikh A., Shenoy S. M., Shetty A., Shetty P. H., Shivakumar K. M., Silva L. M. L. R., Simegn W., Singh J. A., Singh K., Skhvitaridze N., Skryabin V. Y., Skryabina A. A., Socea B., Solomon Y., Song S., Stefan S. C., Suleman M., Tabares-Seisdedos R., Tat N. Y., Tat V. Y., Tefera B. N., Tichopad A., Tobe-Gai R., Tovani-Palone M. R., Tudor Car L., Tufa D. G., Vasankari T. J., Vasic M., Vervoort D., Vlassov V., Vo B., Vu L. G., Waheed Y., Wamai R. G., Wang C., Wassie G. T., Wickramasinghe N. D., Yaya S., Yigit A., Yigit V., Yonemoto N., Younis M. Z., Yu C., Yunusa I., Zaki L., Zaman B. A., Zangeneh A., Zare Dehnavi A., Zastrozhin M. S., Zeng W., Zhang Z. -J., Zuhlke L. J., Zuniga Y. M. H., Hay S. I., Murray C. J. L., and Dieleman J. L.
Abstract: Background: The COVID-19 pandemic highlighted gaps in health surveillance systems, disease prevention, and treatment globally. Among the many factors that might have led to these gaps is the issue of the financing of national health systems, especially in low-income and middle-income countries (LMICs), as well as a robust global system for pandemic preparedness. We aimed to provide a comparative assessment of global health spending at the onset of the pandemic; characterise the amount of development assistance for pandemic preparedness and response disbursed in the first 2 years of the COVID-19 pandemic; and examine expectations for future health spending and put into context the expected need for investment in pandemic preparedness. Methods: In this analysis of global health spending between 1990 and 2021, and prediction from 2021 to 2026, we estimated four sources of health spending: development assistance for health (DAH), government spending, out-of-pocket spending, and prepaid private spending across 204 countries and territories. We used the Organisation for Economic Co-operation and Development (OECD)'s Creditor Reporting System (CRS) and the WHO Global Health Expenditure Database (GHED) to estimate spending. We estimated development assistance for general health, COVID-19 response, and pandemic preparedness and response using a keyword search. Health spending estimates were combined with estimates of resources needed for pandemic prevention and preparedness to analyse future health spending patterns, relative to need. Findings: In 2019, at the onset of the COVID-19 pandemic, US$9·2 trillion (95% uncertainty interval [UI] 9·1–9·3) was spent on health worldwide. We found great disparities in the amount of resources devoted to health, with high-income countries spending $7·3 trillion (95% UI 7·2–7·4) in 2019; 293·7 times the $24·8 billion (95% UI 24·3–25·3) spent by low-income countries in 2019. That same year, $43·1 billion in development assistance was provid
Published: 2023

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, A, Su, Y, Bachmeier, S, Chapin, A, Cogswell, I, Crosby, S, Cunningham, B, Harle, A, Maddison, E, Moitra, M, Sahu, M, Schneider, M, Simpson, K, Stutzman, H, Tsakalos, G, Zende, R, Zlavog, B, Abbafati, C, Abebo, Z, Abolhassani, H, Abrigo, M, Ahmed, M, Akinyemi, R, Alam, K, Ali, S, Alinia, C, Alipour, V, Aljunid, S, Almasi, A, Alvis-Guzman, N, Ancuceanu, R, Andrei, T, Andrei, C, Anjomshoa, M, Antonio, C, Arabloo, J, Arab-Zozani, M, Aremu, O, Atnafu, D, Ausloos, M, Avila-Burgos, L, Ayanore, M, Azari, S, Babalola, T, Bagherzadeh, M, Baig, A, Bakhtiari, A, Banach, M, Banerjee, S, Barnighausen, T, Basu, S, Baune, B, Bayati, M, Berman, A, Bhageerathy, R, Bhardwaj, P, Bohluli, M, Busse, R, Cahuana-Hurtado, L, Camera, L, Castaneda-Orjuela, C, Catala-Lopez, F, Cevik, M, Chattu, V, Dandona, L, Dandona, R, Dianatinasab, M, Do, H, Doshmangir, L, El Tantawi, M, Eskandarieh, S, Esmaeilzadeh, F, Faraj, A, Farzadfar, F, Fischer, F, Foigt, N, Fullman, N, Gad, M, Ghafourifard, M, Ghashghaee, A, Gholamian, A, Goharinezhad, S, Grada, A, Haghparast Bidgoli, H, Hamidi, S, Harb, H, Hasanpoor, E, Hay, S, Hendrie, D, Henry, N, Herteliu, C, Hole, M, Hosseinzadeh, M, Hostiuc, S, Huda, T, Humayun, A, Hwang, B, Ilesanmi, O, Iqbal, U, Irvani, S, Islam, S, Islam, M, Jahani, M, Jakovljevic, M, James, S, Javaheri, Z, Jonas, J, Joukar, F, Jozwiak, J, Jurisson, M, Kalhor, R, Karami Matin, B, Karimi, S, Kayode, G, Kazemi Karyani, A, Kinfu, Y, Kisa, A, Kohler, S, Komaki, H, Kosen, S, Kotlo, A, Koyanagi, A, Kumar, G, Kusuma, D, Lansingh, V, Larsson, A, Lasrado, S, Lee, S, Lim, L, Lozano, R, Magdy Abd El Razek, H, Mahdavi, M, Maleki, S, Malekzadeh, R, Mansour-Ghanaei, F, Mansournia, M, Mantovani, L, Martinez, G, Masoumi, S, Massenburg, B, Menezes, R, Mengesha, E, Meretoja, T, Meretoja, A, Mestrovic, T, Milevska Kostova, N, Miller, T, Mirica, A, Mirrakhimov, E, Moghadaszadeh, M, Mohajer, B, Mohamadi, E, Mohammad Darwesh, A, Mohammadian-Hafshejani, A, Mohammadpourhodki, R, Mohammed, S, Mohebi, F, Mokdad, A, Morrison, S, Mosser, J, Mousavi, S, Muriithi, M, Muthupandian, S, Myint, C, Naderi, M, Nagarajan, A, Nguyen, C, Nguyen, H, Nonvignon, J, Noubiap, J, Oh, I, Olagunju, A, Olusanya, J, Olusanya, B, Omar Bali, A, Onwujekwe, O, Otstavnov, S, Otstavnov, N, Owolabi, M, Padubidri, J, Palladino, R, Panda-Jonas, S, Pandey, A, Postma, M, Prada, S, Pribadi, D, Rabiee, M, Rabiee, N, Rahim, F, Ranabhat, C, Rao, S, Rathi, P, Rawaf, S, Rawaf, D, Rawal, L, Rawassizadeh, R, Rezapour, A, Sabour, S, Sahraian, M, Salman, O, Salomon, J, Samy, A, Sanabria, J, Santos, J, Santric Milicevic, M, Sao Jose, B, Savic, M, Schwendicke, F, Senthilkumaran, S, Sepanlou, S, Servan-Mori, E, Setayesh, H, Shaikh, M, Sheikh, A, Shibuya, K, Shrime, M, Simonetti, B, Singh, J, Singh, P, Skryabin, V, Soheili, A, Soltani, S, Stefan, S, Tabares-Seisdedos, R, Topor-Madry, R, Tovani-Palone, M, Tran, B, Travillian, R, Undurraga, E, Valdez, P, van Boven, J, Vasankari, T, Violante, F, Vlassov, V, Vos, T, Wolfe, C, Wu, J, Yaya, S, Yazdi-Feyzabadi, V, Yip, P, Yonemoto, N, Younis, M, Yu, C, Zaidi, Z, Zaman, S, Zastrozhin, M, Zhang, Z, Zhao, Y, Murray, C, Dieleman, J, Micah A. E., Su Y., Bachmeier S. D., Chapin A., Cogswell I. E., Crosby S. W., Cunningham B., Harle A. C., Maddison E. R., Moitra M., Sahu M., Schneider M. T., Simpson K. E., Stutzman H. N., Tsakalos G., Zende R. R., Zlavog B. S., Abbafati C., Abebo Z. H., Abolhassani H., Abrigo M. R. M., Ahmed M. B., Akinyemi R. O., Alam K., Ali S., Alinia C., Alipour V., Aljunid S. M., Almasi A., Alvis-Guzman N., Ancuceanu R., Andrei T., Andrei C. L., Anjomshoa M., Antonio C. A. T., Arabloo J., Arab-Zozani M., Aremu O., Atnafu D. D., Ausloos M., Avila-Burgos L., Ayanore M. A., Azari S., Babalola T. K., Bagherzadeh M., Baig A. A., Bakhtiari A., Banach M., Banerjee S. K., Barnighausen T. W., Basu S., Baune B. T., Bayati M., Berman A. E., Bhageerathy R., Bhardwaj P., Bohluli M., Busse R., Cahuana-Hurtado L., Camera L. L. A., Castaneda-Orjuela C. A., Catala-Lopez F., Cevik M., Chattu V. K., Dandona L., Dandona R., Dianatinasab M., Do H. T., Doshmangir L., El Tantawi M., Eskandarieh S., Esmaeilzadeh F., Faraj A., Farzadfar F., Fischer F., Foigt N. A., Fullman N., Gad M. M., Ghafourifard M., Ghashghaee A., Gholamian A., Goharinezhad S., Grada A., Haghparast Bidgoli H., Hamidi S., Harb H. L., Hasanpoor E., Hay S. I., Hendrie D., Henry N. J., Herteliu C., Hole M. K., Hosseinzadeh M., Hostiuc S., Huda T. M., Humayun A., Hwang B. -F., Ilesanmi O. S., Iqbal U., Irvani S. S. N., Islam S. M. S., Islam M. M., Jahani M. A., Jakovljevic M., James S. L., Javaheri Z., Jonas J. B., Joukar F., Jozwiak J. J., Jurisson M., Kalhor R., Karami Matin B., Karimi S. E., Kayode G. A., Kazemi Karyani A., Kinfu Y., Kisa A., Kohler S., Komaki H., Kosen S., Kotlo A., Koyanagi A., Kumar G. A., Kusuma D., Lansingh V. C., Larsson A. O., Lasrado S., Lee S. W. H., Lim L. -L., Lozano R., Magdy Abd El Razek H., Mahdavi M. M., Maleki S., Malekzadeh R., Mansour-Ghanaei F., Mansournia M. A., Mantovani L. G., Martinez G., Masoumi S. Z., Massenburg B. B., Menezes R. G., Mengesha E. W., Meretoja T. J., Meretoja A., Mestrovic T., Milevska Kostova N., Miller T. R., Mirica A., Mirrakhimov E. M., Moghadaszadeh M., Mohajer B., Mohamadi E., Mohammad Darwesh A., Mohammadian-Hafshejani A., Mohammadpourhodki R., Mohammed S., Mohebi F., Mokdad A. H., Morrison S. D., Mosser J. F., Mousavi S. M., Muriithi M. K., Muthupandian S., Myint C. -Y., Naderi M., Nagarajan A. J., Nguyen C. T., Nguyen H. L. T., Nonvignon J., Noubiap J. J., Oh I. -H., Olagunju A. T., Olusanya J. O., Olusanya B. O., Omar Bali A., Onwujekwe O. E., Otstavnov S. S., Otstavnov N., Owolabi M. O., Padubidri J. R., Palladino R., Panda-Jonas S., Pandey A., Postma M. J., Prada S. I., Pribadi D. R. A., Rabiee M., Rabiee N., Rahim F., Ranabhat C. L., Rao S. J., Rathi P., Rawaf S., Rawaf D. L., Rawal L., Rawassizadeh R., Rezapour A., Sabour S., Sahraian M. A., Salman O. M., Salomon J. A., Samy A. M., Sanabria J., Santos J. V., Santric Milicevic M. M., Sao Jose B. P., Savic M., Schwendicke F., Senthilkumaran S., Sepanlou S. G., Servan-Mori E., Setayesh H., Shaikh M. A., Sheikh A., Shibuya K., Shrime M. G., Simonetti B., Singh J. A., Singh P., Skryabin V. Y., Soheili A., Soltani S., Stefan S. C., Tabares-Seisdedos R., Topor-Madry R., Tovani-Palone M. R., Tran B. X., Travillian R., Undurraga E. A., Valdez P. R., van Boven J. F. M., Vasankari T. J., Violante F. S., Vlassov V., Vos T., Wolfe C. D. A., Wu J., Yaya S., Yazdi-Feyzabadi V., Yip P., Yonemoto N., Younis M. Z., Yu C., Zaidi Z., Zaman S. B., Zastrozhin M. S., Zhang Z. -J., Zhao Y., Murray C. J. L., Dieleman J. L., Micah, A, Su, Y, Bachmeier, S, Chapin, A, Cogswell, I, Crosby, S, Cunningham, B, Harle, A, Maddison, E, Moitra, M, Sahu, M, Schneider, M, Simpson, K, Stutzman, H, Tsakalos, G, Zende, R, Zlavog, B, Abbafati, C, Abebo, Z, Abolhassani, H, Abrigo, M, Ahmed, M, Akinyemi, R, Alam, K, Ali, S, Alinia, C, Alipour, V, Aljunid, S, Almasi, A, Alvis-Guzman, N, Ancuceanu, R, Andrei, T, Andrei, C, Anjomshoa, M, Antonio, C, Arabloo, J, Arab-Zozani, M, Aremu, O, Atnafu, D, Ausloos, M, Avila-Burgos, L, Ayanore, M, Azari, S, Babalola, T, Bagherzadeh, M, Baig, A, Bakhtiari, A, Banach, M, Banerjee, S, Barnighausen, T, Basu, S, Baune, B, Bayati, M, Berman, A, Bhageerathy, R, Bhardwaj, P, Bohluli, M, Busse, R, Cahuana-Hurtado, L, Camera, L, Castaneda-Orjuela, C, Catala-Lopez, F, Cevik, M, Chattu, V, Dandona, L, Dandona, R, Dianatinasab, M, Do, H, Doshmangir, L, El Tantawi, M, Eskandarieh, S, Esmaeilzadeh, F, Faraj, A, Farzadfar, F, Fischer, F, Foigt, N, Fullman, N, Gad, M, Ghafourifard, M, Ghashghaee, A, Gholamian, A, Goharinezhad, S, Grada, A, Haghparast Bidgoli, H, Hamidi, S, Harb, H, Hasanpoor, E, Hay, S, Hendrie, D, Henry, N, Herteliu, C, Hole, M, Hosseinzadeh, M, Hostiuc, S, Huda, T, Humayun, A, Hwang, B, Ilesanmi, O, Iqbal, U, Irvani, S, Islam, S, Islam, M, Jahani, M, Jakovljevic, M, James, S, Javaheri, Z, Jonas, J, Joukar, F, Jozwiak, J, Jurisson, M, Kalhor, R, Karami Matin, B, Karimi, S, Kayode, G, Kazemi Karyani, A, Kinfu, Y, Kisa, A, Kohler, S, Komaki, H, Kosen, S, Kotlo, A, Koyanagi, A, Kumar, G, Kusuma, D, Lansingh, V, Larsson, A, Lasrado, S, Lee, S, Lim, L, Lozano, R, Magdy Abd El Razek, H, Mahdavi, M, Maleki, S, Malekzadeh, R, Mansour-Ghanaei, F, Mansournia, M, Mantovani, L, Martinez, G, Masoumi, S, Massenburg, B, Menezes, R, Mengesha, E, Meretoja, T, Meretoja, A, Mestrovic, T, Milevska Kostova, N, Miller, T, Mirica, A, Mirrakhimov, E, Moghadaszadeh, M, Mohajer, B, Mohamadi, E, Mohammad Darwesh, A, Mohammadian-Hafshejani, A, Mohammadpourhodki, R, Mohammed, S, Mohebi, F, Mokdad, A, Morrison, S, Mosser, J, Mousavi, S, Muriithi, M, Muthupandian, S, Myint, C, Naderi, M, Nagarajan, A, Nguyen, C, Nguyen, H, Nonvignon, J, Noubiap, J, Oh, I, Olagunju, A, Olusanya, J, Olusanya, B, Omar Bali, A, Onwujekwe, O, Otstavnov, S, Otstavnov, N, Owolabi, M, Padubidri, J, Palladino, R, Panda-Jonas, S, Pandey, A, Postma, M, Prada, S, Pribadi, D, Rabiee, M, Rabiee, N, Rahim, F, Ranabhat, C, Rao, S, Rathi, P, Rawaf, S, Rawaf, D, Rawal, L, Rawassizadeh, R, Rezapour, A, Sabour, S, Sahraian, M, Salman, O, Salomon, J, Samy, A, Sanabria, J, Santos, J, Santric Milicevic, M, Sao Jose, B, Savic, M, Schwendicke, F, Senthilkumaran, S, Sepanlou, S, Servan-Mori, E, Setayesh, H, Shaikh, M, Sheikh, A, Shibuya, K, Shrime, M, Simonetti, B, Singh, J, Singh, P, Skryabin, V, Soheili, A, Soltani, S, Stefan, S, Tabares-Seisdedos, R, Topor-Madry, R, Tovani-Palone, M, Tran, B, Travillian, R, Undurraga, E, Valdez, P, van Boven, J, Vasankari, T, Violante, F, Vlassov, V, Vos, T, Wolfe, C, Wu, J, Yaya, S, Yazdi-Feyzabadi, V, Yip, P, Yonemoto, N, Younis, M, Yu, C, Zaidi, Z, Zaman, S, Zastrozhin, M, Zhang, Z, Zhao, Y, Murray, C, Dieleman, J, Micah A. E., Su Y., Bachmeier S. D., Chapin A., Cogswell I. E., Crosby S. W., Cunningham B., Harle A. C., Maddison E. R., Moitra M., Sahu M., Schneider M. T., Simpson K. E., Stutzman H. N., Tsakalos G., Zende R. R., Zlavog B. S., Abbafati C., Abebo Z. H., Abolhassani H., Abrigo M. R. M., Ahmed M. B., Akinyemi R. O., Alam K., Ali S., Alinia C., Alipour V., Aljunid S. M., Almasi A., Alvis-Guzman N., Ancuceanu R., Andrei T., Andrei C. L., Anjomshoa M., Antonio C. A. T., Arabloo J., Arab-Zozani M., Aremu O., Atnafu D. D., Ausloos M., Avila-Burgos L., Ayanore M. A., Azari S., Babalola T. K., Bagherzadeh M., Baig A. A., Bakhtiari A., Banach M., Banerjee S. K., Barnighausen T. W., Basu S., Baune B. T., Bayati M., Berman A. E., Bhageerathy R., Bhardwaj P., Bohluli M., Busse R., Cahuana-Hurtado L., Camera L. L. A., Castaneda-Orjuela C. A., Catala-Lopez F., Cevik M., Chattu V. K., Dandona L., Dandona R., Dianatinasab M., Do H. T., Doshmangir L., El Tantawi M., Eskandarieh S., Esmaeilzadeh F., Faraj A., Farzadfar F., Fischer F., Foigt N. A., Fullman N., Gad M. M., Ghafourifard M., Ghashghaee A., Gholamian A., Goharinezhad S., Grada A., Haghparast Bidgoli H., Hamidi S., Harb H. L., Hasanpoor E., Hay S. I., Hendrie D., Henry N. J., Herteliu C., Hole M. K., Hosseinzadeh M., Hostiuc S., Huda T. M., Humayun A., Hwang B. -F., Ilesanmi O. S., Iqbal U., Irvani S. S. N., Islam S. M. S., Islam M. M., Jahani M. A., Jakovljevic M., James S. L., Javaheri Z., Jonas J. B., Joukar F., Jozwiak J. J., Jurisson M., Kalhor R., Karami Matin B., Karimi S. E., Kayode G. A., Kazemi Karyani A., Kinfu Y., Kisa A., Kohler S., Komaki H., Kosen S., Kotlo A., Koyanagi A., Kumar G. A., Kusuma D., Lansingh V. C., Larsson A. O., Lasrado S., Lee S. W. H., Lim L. -L., Lozano R., Magdy Abd El Razek H., Mahdavi M. M., Maleki S., Malekzadeh R., Mansour-Ghanaei F., Mansournia M. A., Mantovani L. G., Martinez G., Masoumi S. Z., Massenburg B. B., Menezes R. G., Mengesha E. W., Meretoja T. J., Meretoja A., Mestrovic T., Milevska Kostova N., Miller T. R., Mirica A., Mirrakhimov E. M., Moghadaszadeh M., Mohajer B., Mohamadi E., Mohammad Darwesh A., Mohammadian-Hafshejani A., Mohammadpourhodki R., Mohammed S., Mohebi F., Mokdad A. H., Morrison S. D., Mosser J. F., Mousavi S. M., Muriithi M. K., Muthupandian S., Myint C. -Y., Naderi M., Nagarajan A. J., Nguyen C. T., Nguyen H. L. T., Nonvignon J., Noubiap J. J., Oh I. -H., Olagunju A. T., Olusanya J. O., Olusanya B. O., Omar Bali A., Onwujekwe O. E., Otstavnov S. S., Otstavnov N., Owolabi M. O., Padubidri J. R., Palladino R., Panda-Jonas S., Pandey A., Postma M. J., Prada S. I., Pribadi D. R. A., Rabiee M., Rabiee N., Rahim F., Ranabhat C. L., Rao S. J., Rathi P., Rawaf S., Rawaf D. L., Rawal L., Rawassizadeh R., Rezapour A., Sabour S., Sahraian M. A., Salman O. M., Salomon J. A., Samy A. M., Sanabria J., Santos J. V., Santric Milicevic M. M., Sao Jose B. P., Savic M., Schwendicke F., Senthilkumaran S., Sepanlou S. G., Servan-Mori E., Setayesh H., Shaikh M. A., Sheikh A., Shibuya K., Shrime M. G., Simonetti B., Singh J. A., Singh P., Skryabin V. Y., Soheili A., Soltani S., Stefan S. C., Tabares-Seisdedos R., Topor-Madry R., Tovani-Palone M. R., Tran B. X., Travillian R., Undurraga E. A., Valdez P. R., van Boven J. F. M., Vasankari T. J., Violante F. S., Vlassov V., Vos T., Wolfe C. D. A., Wu J., Yaya S., Yazdi-Feyzabadi V., Yip P., Yonemoto N., Younis M. Z., Yu C., Zaidi Z., Zaman S. B., Zastrozhin M. S., Zhang Z. -J., Zhao Y., Murray C. J. L., and Dieleman J. L.
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. Past, present, and future of global health financing: A review of development assistance, government, out-of-pocket, and other private spending on health for 195 countries, 1995-2050

Author: Chang, A, Cowling, K, Micah, A, Chapin, A, Chen, C, Ikilezi, G, Sadat, N, Tsakalos, G, Wu, J, Younker, T, Zhao, Y, Zlavog, B, Abbafati, C, Ahmed, A, Alam, K, Alipour, V, Aljunid, S, Almalki, M, Alvis-Guzman, N, Ammar, W, Andrei, C, Anjomshoa, M, Antonio, C, Arabloo, J, Aremu, O, Ausloos, M, Avila-Burgos, L, Awasthi, A, Ayanore, M, Azari, S, Azzopardi-Muscat, N, Bagherzadeh, M, Barnighausen, T, Baune, B, Bayati, M, Belay, Y, Belete, H, Berbada, D, Berman, A, Beuran, M, Bijani, A, Busse, R, Cahuana-Hurtado, L, Camera, L, Catala-Lopez, F, Chauhan, B, Constantin, M, Crowe, C, Cucu, A, Dalal, K, De Neve, J, Deiparine, S, Demeke, F, Do, H, Dubey, M, Tantawi, M, Eskandarieh, S, Esmaeili, R, Fakhar, M, Fazaeli, A, Fischer, F, Foigt, N, Fukumoto, T, Fullman, N, Galan, A, Gamkrelidze, A, Gezae, K, Ghajar, A, Ghashghaee, A, Goginashvili, K, Haakenstad, A, Bidgoli, H, Hamidi, S, Harb, H, Hasanpoor, E, Hassen, H, Hay, S, Hendrie, D, Henok, A, Heredia-Pi, I, Herteliu, C, Hoang, C, Hole, M, Rad, E, Hossain, N, Hosseinzadeh, M, Hostiuc, S, Ilesanmi, O, Irvani, S, Jakovljevic, M, Jalali, A, James, S, Jonas, J, Jurisson, M, Kadel, R, Matin, B, Kasaeian, A, Kasaye, H, Kassaw, M, Karyani, A, Khabiri, R, Khan, J, Khan, M, Khang, Y, Kisa, A, Kissimova-Skarbek, K, Kohler, S, Koyanagi, A, Krohn, K, Leung, R, Lim, L, Lorkowski, S, Majeed, A, Malekzadeh, R, Mansourian, M, Mantovani, L, Massenburg, B, Mckee, M, Mehta, V, Meretoja, A, Meretoja, T, Kostova, N, Miller, T, Mirrakhimov, E, Mohajer, B, Darwesh, A, Mohammed, S, Mohebi, F, Mokdad, A, Morrison, S, Mousavi, S, Muthupandian, S, Nagarajan, A, Nangia, V, Negoi, I, Nguyen, C, Nguyen, H, Nguyen, S, Nosratnejad, S, Oladimeji, O, Olgiati, S, Olusanya, J, Onwujekwe, O, Otstavnov, S, Pana, A, Pereira, D, Piroozi, B, Prada, S, Qorbani, M, Rabiee, M, Rabiee, N, Rafiei, A, Rahim, F, Rahimi-Movaghar, V, Ram, U, Ranabhat, C, Ranta, A, Rawaf, D, Rawaf, S, Rezaei, S, Roro, E, Rostami, A, Rubino, S, Salahshoor, M, Samy, A, Sanabria, J, Santos, J, Milicevic, M, Jose, B, Savic, M, Schwendicke, F, Sepanlou, S, Sepehrimanesh, M, Sheikh, A, Shrime, M, Sisay, S, Soltani, S, Soofi, M, Srinivasan, V, Tabares-Seisdedos, R, Torre, A, Tovani-Palone, M, Tran, B, Tran, K, Undurraga, E, Valdez, P, Van Boven, J, Vargas, V, Veisani, Y, Violante, F, Vladimirov, S, Vlassov, V, Vollmer, S, Vu, G, Wolfe, C, Yonemoto, N, Younis, M, Yousefifard, M, Zaman, S, Zangeneh, A, Zegeye, E, Ziapour, A, Chew, A, Murray, C, Dieleman, J, Chang A. Y., Cowling K., Micah A. E., Chapin A., Chen C. S., Ikilezi G., Sadat N., Tsakalos G., Wu J., Younker T., Zhao Y., Zlavog B. S., Abbafati C., Ahmed A. E., Alam K., Alipour V., Aljunid S. M., Almalki M. J., Alvis-Guzman N., Ammar W., Andrei C. L., Anjomshoa M., Antonio C. A. T., Arabloo J., Aremu O., Ausloos M., Avila-Burgos L., Awasthi A., Ayanore M. A., Azari S., Azzopardi-Muscat N., Bagherzadeh M., Barnighausen T. W., Baune B. T., Bayati M., Belay Y. B., Belay Y. A., Belete H., Berbada D. A., Berman A. E., Beuran M., Bijani A., Busse R., Cahuana-Hurtado L., Camera L. A., Catala-Lopez F., Chauhan B. G., Constantin M. -M., Crowe C. S., Cucu A., Dalal K., De Neve J. -W., Deiparine S., Demeke F. M., Do H. P., Dubey M., Tantawi M. E., Eskandarieh S., Esmaeili R., Fakhar M., Fazaeli A. A., Fischer F., Foigt N. A., Fukumoto T., Fullman N., Galan A., Gamkrelidze A., Gezae K. E., Ghajar A., Ghashghaee A., Goginashvili K., Haakenstad A., Bidgoli H. H., Hamidi S., Harb H. L., Hasanpoor E., Hassen H. Y., Hay S. I., Hendrie D., Henok A., Heredia-Pi I., Herteliu C., Hoang C. L., Hole M. K., Rad E. H., Hossain N., Hosseinzadeh M., Hostiuc S., Ilesanmi O. S., Irvani S. S. N., Jakovljevic M., Jalali A., James S. L., Jonas J. B., Jurisson M., Kadel R., Matin B. K., Kasaeian A., Kasaye H. K., Kassaw M. W., Karyani A. K., Khabiri R., Khan J., Khan M. N., Khang Y. -H., Kisa A., Kissimova-Skarbek K., Kohler S., Koyanagi A., Krohn K. J., Leung R., Lim L. -L., Lorkowski S., Majeed A., Malekzadeh R., Mansourian M., Mantovani L. G., Massenburg B. B., Mckee M., Mehta V., Meretoja A., Meretoja T. J., Kostova N. M., Miller T. R., Mirrakhimov E. M., Mohajer B., Darwesh A. M., Mohammed S., Mohebi F., Mokdad A. H., Morrison S. D., Mousavi S. M., Muthupandian S., Nagarajan A. J., Nangia V., Negoi I., Nguyen C. T., Nguyen H. L. T., Nguyen S. H., Nosratnejad S., Oladimeji O., Olgiati S., Olusanya J. O., Onwujekwe O. E., Otstavnov S. S., Pana A., Pereira D. M., Piroozi B., Prada S. I., Qorbani M., Rabiee M., Rabiee N., Rafiei A., Rahim F., Rahimi-Movaghar V., Ram U., Ranabhat C. L., Ranta A., Rawaf D. L., Rawaf S., Rezaei S., Roro E. M., Rostami A., Rubino S., Salahshoor M., Samy A. M., Sanabria J., Santos J. V., Milicevic M. M. S., Jose B. P. S., Savic M., Schwendicke F., Sepanlou S. G., Sepehrimanesh M., Sheikh A., Shrime M. G., Sisay S., Soltani S., Soofi M., Srinivasan V., Tabares-Seisdedos R., Torre A., Tovani-Palone M. R., Tran B. X., Tran K. B., Undurraga E. A., Valdez P. R., Van Boven J. F. M., Vargas V., Veisani Y., Violante F. S., Vladimirov S. K., Vlassov V., Vollmer S., Vu G. T., Wolfe C. D. A., Yonemoto N., Younis M. Z., Yousefifard M., Zaman S. B., Zangeneh A., Zegeye E. A., Ziapour A., Chew A., Murray C. J. L., Dieleman J. L., Chang, A, Cowling, K, Micah, A, Chapin, A, Chen, C, Ikilezi, G, Sadat, N, Tsakalos, G, Wu, J, Younker, T, Zhao, Y, Zlavog, B, Abbafati, C, Ahmed, A, Alam, K, Alipour, V, Aljunid, S, Almalki, M, Alvis-Guzman, N, Ammar, W, Andrei, C, Anjomshoa, M, Antonio, C, Arabloo, J, Aremu, O, Ausloos, M, Avila-Burgos, L, Awasthi, A, Ayanore, M, Azari, S, Azzopardi-Muscat, N, Bagherzadeh, M, Barnighausen, T, Baune, B, Bayati, M, Belay, Y, Belete, H, Berbada, D, Berman, A, Beuran, M, Bijani, A, Busse, R, Cahuana-Hurtado, L, Camera, L, Catala-Lopez, F, Chauhan, B, Constantin, M, Crowe, C, Cucu, A, Dalal, K, De Neve, J, Deiparine, S, Demeke, F, Do, H, Dubey, M, Tantawi, M, Eskandarieh, S, Esmaeili, R, Fakhar, M, Fazaeli, A, Fischer, F, Foigt, N, Fukumoto, T, Fullman, N, Galan, A, Gamkrelidze, A, Gezae, K, Ghajar, A, Ghashghaee, A, Goginashvili, K, Haakenstad, A, Bidgoli, H, Hamidi, S, Harb, H, Hasanpoor, E, Hassen, H, Hay, S, Hendrie, D, Henok, A, Heredia-Pi, I, Herteliu, C, Hoang, C, Hole, M, Rad, E, Hossain, N, Hosseinzadeh, M, Hostiuc, S, Ilesanmi, O, Irvani, S, Jakovljevic, M, Jalali, A, James, S, Jonas, J, Jurisson, M, Kadel, R, Matin, B, Kasaeian, A, Kasaye, H, Kassaw, M, Karyani, A, Khabiri, R, Khan, J, Khan, M, Khang, Y, Kisa, A, Kissimova-Skarbek, K, Kohler, S, Koyanagi, A, Krohn, K, Leung, R, Lim, L, Lorkowski, S, Majeed, A, Malekzadeh, R, Mansourian, M, Mantovani, L, Massenburg, B, Mckee, M, Mehta, V, Meretoja, A, Meretoja, T, Kostova, N, Miller, T, Mirrakhimov, E, Mohajer, B, Darwesh, A, Mohammed, S, Mohebi, F, Mokdad, A, Morrison, S, Mousavi, S, Muthupandian, S, Nagarajan, A, Nangia, V, Negoi, I, Nguyen, C, Nguyen, H, Nguyen, S, Nosratnejad, S, Oladimeji, O, Olgiati, S, Olusanya, J, Onwujekwe, O, Otstavnov, S, Pana, A, Pereira, D, Piroozi, B, Prada, S, Qorbani, M, Rabiee, M, Rabiee, N, Rafiei, A, Rahim, F, Rahimi-Movaghar, V, Ram, U, Ranabhat, C, Ranta, A, Rawaf, D, Rawaf, S, Rezaei, S, Roro, E, Rostami, A, Rubino, S, Salahshoor, M, Samy, A, Sanabria, J, Santos, J, Milicevic, M, Jose, B, Savic, M, Schwendicke, F, Sepanlou, S, Sepehrimanesh, M, Sheikh, A, Shrime, M, Sisay, S, Soltani, S, Soofi, M, Srinivasan, V, Tabares-Seisdedos, R, Torre, A, Tovani-Palone, M, Tran, B, Tran, K, Undurraga, E, Valdez, P, Van Boven, J, Vargas, V, Veisani, Y, Violante, F, Vladimirov, S, Vlassov, V, Vollmer, S, Vu, G, Wolfe, C, Yonemoto, N, Younis, M, Yousefifard, M, Zaman, S, Zangeneh, A, Zegeye, E, Ziapour, A, Chew, A, Murray, C, Dieleman, J, Chang A. Y., Cowling K., Micah A. E., Chapin A., Chen C. S., Ikilezi G., Sadat N., Tsakalos G., Wu J., Younker T., Zhao Y., Zlavog B. S., Abbafati C., Ahmed A. E., Alam K., Alipour V., Aljunid S. M., Almalki M. J., Alvis-Guzman N., Ammar W., Andrei C. L., Anjomshoa M., Antonio C. A. T., Arabloo J., Aremu O., Ausloos M., Avila-Burgos L., Awasthi A., Ayanore M. A., Azari S., Azzopardi-Muscat N., Bagherzadeh M., Barnighausen T. W., Baune B. T., Bayati M., Belay Y. B., Belay Y. A., Belete H., Berbada D. A., Berman A. E., Beuran M., Bijani A., Busse R., Cahuana-Hurtado L., Camera L. A., Catala-Lopez F., Chauhan B. G., Constantin M. -M., Crowe C. S., Cucu A., Dalal K., De Neve J. -W., Deiparine S., Demeke F. M., Do H. P., Dubey M., Tantawi M. E., Eskandarieh S., Esmaeili R., Fakhar M., Fazaeli A. A., Fischer F., Foigt N. A., Fukumoto T., Fullman N., Galan A., Gamkrelidze A., Gezae K. E., Ghajar A., Ghashghaee A., Goginashvili K., Haakenstad A., Bidgoli H. H., Hamidi S., Harb H. L., Hasanpoor E., Hassen H. Y., Hay S. I., Hendrie D., Henok A., Heredia-Pi I., Herteliu C., Hoang C. L., Hole M. K., Rad E. H., Hossain N., Hosseinzadeh M., Hostiuc S., Ilesanmi O. S., Irvani S. S. N., Jakovljevic M., Jalali A., James S. L., Jonas J. B., Jurisson M., Kadel R., Matin B. K., Kasaeian A., Kasaye H. K., Kassaw M. W., Karyani A. K., Khabiri R., Khan J., Khan M. N., Khang Y. -H., Kisa A., Kissimova-Skarbek K., Kohler S., Koyanagi A., Krohn K. J., Leung R., Lim L. -L., Lorkowski S., Majeed A., Malekzadeh R., Mansourian M., Mantovani L. G., Massenburg B. B., Mckee M., Mehta V., Meretoja A., Meretoja T. J., Kostova N. M., Miller T. R., Mirrakhimov E. M., Mohajer B., Darwesh A. M., Mohammed S., Mohebi F., Mokdad A. H., Morrison S. D., Mousavi S. M., Muthupandian S., Nagarajan A. J., Nangia V., Negoi I., Nguyen C. T., Nguyen H. L. T., Nguyen S. H., Nosratnejad S., Oladimeji O., Olgiati S., Olusanya J. O., Onwujekwe O. E., Otstavnov S. S., Pana A., Pereira D. M., Piroozi B., Prada S. I., Qorbani M., Rabiee M., Rabiee N., Rafiei A., Rahim F., Rahimi-Movaghar V., Ram U., Ranabhat C. L., Ranta A., Rawaf D. L., Rawaf S., Rezaei S., Roro E. M., Rostami A., Rubino S., Salahshoor M., Samy A. M., Sanabria J., Santos J. V., Milicevic M. M. S., Jose B. P. S., Savic M., Schwendicke F., Sepanlou S. G., Sepehrimanesh M., Sheikh A., Shrime M. G., Sisay S., Soltani S., Soofi M., Srinivasan V., Tabares-Seisdedos R., Torre A., Tovani-Palone M. R., Tran B. X., Tran K. B., Undurraga E. A., Valdez P. R., Van Boven J. F. M., Vargas V., Veisani Y., Violante F. S., Vladimirov S. K., Vlassov V., Vollmer S., Vu G. T., Wolfe C. D. A., Yonemoto N., Younis M. Z., Yousefifard M., Zaman S. B., Zangeneh A., Zegeye E. A., Ziapour A., Chew A., Murray C. J. L., and Dieleman J. L.
Abstract: Background: Comprehensive and comparable estimates of health spending in each country are a key input for health policy and planning, and are necessary to support the achievement of national and international health goals. Previous studies have tracked past and projected future health spending until 2040 and shown that, with economic development, countries tend to spend more on health per capita, with a decreasing share of spending from development assistance and out-of-pocket sources. We aimed to characterise the past, present, and predicted future of global health spending, with an emphasis on equity in spending across countries. Methods: We estimated domestic health spending for 195 countries and territories from 1995 to 2016, split into three categories-government, out-of-pocket, and prepaid private health spending-and estimated development assistance for health (DAH) from 1990 to 2018. We estimated future scenarios of health spending using an ensemble of linear mixed-effects models with time series specifications to project domestic health spending from 2017 through 2050 and DAH from 2019 through 2050. Data were extracted from a broad set of sources tracking health spending and revenue, and were standardised and converted to inflation-adjusted 2018 US dollars. Incomplete or low-quality data were modelled and uncertainty was estimated, leading to a complete data series of total, government, prepaid private, and out-of-pocket health spending, and DAH. Estimates are reported in 2018 US dollars, 2018 purchasing-power parity-adjusted dollars, and as a percentage of gross domestic product. We used demographic decomposition methods to assess a set of factors associated with changes in government health spending between 1995 and 2016 and to examine evidence to support the theory of the health financing transition. We projected two alternative future scenarios based on higher government health spending to assess the potential ability of governments to generate more reso
Published: 2019

4. Past, present, and future of global health financing : A review of development assistance, government, out-of-pocket, and other private spending on health for 195 countries, 1995-2050

Author: Chang, A. Y., Cowling, K., Micah, A. E., Chapin, A., Chen, C. S., Ikilezi, G., Sadat, N., Tsakalos, G., Wu, J., Younker, T., Zhao, Y., Zlavog, B. S., Abbafati, C., Ahmed, A. E., Alam, K., Alipour, V., Aljunid, S. M., Almalki, M. J., Alvis-Guzman, N., Ammar, W., Andrei, C. L., Anjomshoa, M., Antonio, C. A. T., Arabloo, J., Aremu, O., Ausloos, M., Avila-Burgos, L., Awasthi, A., Ayanore, M. A., Azari, S., Azzopardi-Muscat, N., Bagherzadeh, M., BÃ€rnighausen, T. W., Baune, B. T., Bayati, M., Belay, Y. B., Belay, Y. A., Belete, H., Berbada, D. A., Berman, A. E., Beuran, M., Bijani, A., Busse, R., Cahuana-Hurtado, L., CÃ¡mera, L. A., CatalÃ¡-LÃ³pez, F., Chauhan, B. G., Constantin, M. -M, Crowe, C. S., Cucu, A., Dalal, Koustuv, De Neve, J. -W, Deiparine, S., Demeke, F. M., Do, H. P., Dubey, M., Tantawi, M. E., Eskandarieh, S., Esmaeili, R., Fakhar, M., Fazaeli, A. A., Fischer, F., Foigt, N. A., Fukumoto, T., Fullman, N., Galan, A., Gamkrelidze, A., Gezae, K. E., Ghajar, A., Ghashghaee, A., Goginashvili, K., Haakenstad, A., Bidgoli, H. H., Hamidi, S., Harb, H. L., Hasanpoor, E., Hassen, H. Y., Hay, S. I., Hendrie, D., Henok, A., Heredia-Pi, I., Herteliu, C., Hoang, C. L., Hole, M. K., Rad, E. H., Hossain, N., Hosseinzadeh, M., Hostiuc, S., Ilesanmi, O. S., Irvani, S. S. N., Jakovljevic, M., Jalali, A., James, S. L., Jonas, J. B., JÃŒrisson, M., Kadel, R., Matin, B. K., Kasaeian, A., Kasaye, H. K., Kassaw, M. W., Karyani, A. K., Khabiri, R., Khan, J., Khan, M. N., Khang, Y. -H, Kisa, A., Kissimova-Skarbek, K., Kohler, S., Koyanagi, A., Krohn, K. J., Leung, R., Lim, L. -L, Lorkowski, S., Majeed, A., Malekzadeh, R., Mansourian, M., Mantovani, L. G., Massenburg, B. B., Mckee, M., Mehta, V., Meretoja, A., Meretoja, T. J., Kostova, N. M., Miller, T. R., Mirrakhimov, E. M., Mohajer, B., Darwesh, A. M., Mohammed, S., Mohebi, F., Mokdad, A. H., Morrison, S. D., Mousavi, S. M., Muthupandian, S., Nagarajan, A. J., Nangia, V., Negoi, I., Nguyen, C. T., Nguyen, H. L. T., Nguyen, S. H., Nosratnejad, S., Oladimeji, O., Olgiati, S., Olusanya, J. O., Onwujekwe, O. E., Otstavnov, S. S., Pana, A., Pereira, D. M., Piroozi, B., Prada, S. I., Qorbani, M., Rabiee, M., Rabiee, N., Rafiei, A., Rahim, F., Rahimi-Movaghar, V., Ram, U., Ranabhat, C. L., Ranta, A., Rawaf, D. L., Rawaf, S., Rezaei, S., Roro, E. M., Rostami, A., Rubino, S., Salahshoor, M., Samy, A. M., Sanabria, J., Santos, J. V., Milicevic, M. M. S., Jose, B. P. S., Savic, M., Schwendicke, F., Sepanlou, S. G., Sepehrimanesh, M., Sheikh, A., Shrime, M. G., Sisay, S., Soltani, S., Soofi, M., Srinivasan, V., TabarÃ©s-Seisdedos, R., Torre, A., Tovani-Palone, M. R., Tran, B. X., Tran, K. B., Undurraga, E. A., Valdez, P. R., Van Boven, J. F. M., Vargas, V., Veisani, Y., Violante, F. S., Vladimirov, S. K., Vlassov, V., Vollmer, S., Vu, G. T., Wolfe, C. D. A., Yonemoto, N., Younis, M. Z., Yousefifard, M., Zaman, S. B., Zangeneh, A., Zegeye, E. A., Ziapour, A., Chew, A., Murray, C. J. L., Dieleman, J. L., Network, Global Burden of Disease Health Financing Collaborator, Chang, A. Y., Cowling, K., Micah, A. E., Chapin, A., Chen, C. S., Ikilezi, G., Sadat, N., Tsakalos, G., Wu, J., Younker, T., Zhao, Y., Zlavog, B. S., Abbafati, C., Ahmed, A. E., Alam, K., Alipour, V., Aljunid, S. M., Almalki, M. J., Alvis-Guzman, N., Ammar, W., Andrei, C. L., Anjomshoa, M., Antonio, C. A. T., Arabloo, J., Aremu, O., Ausloos, M., Avila-Burgos, L., Awasthi, A., Ayanore, M. A., Azari, S., Azzopardi-Muscat, N., Bagherzadeh, M., BÃ€rnighausen, T. W., Baune, B. T., Bayati, M., Belay, Y. B., Belay, Y. A., Belete, H., Berbada, D. A., Berman, A. E., Beuran, M., Bijani, A., Busse, R., Cahuana-Hurtado, L., CÃ¡mera, L. A., CatalÃ¡-LÃ³pez, F., Chauhan, B. G., Constantin, M. -M, Crowe, C. S., Cucu, A., Dalal, Koustuv, De Neve, J. -W, Deiparine, S., Demeke, F. M., Do, H. P., Dubey, M., Tantawi, M. E., Eskandarieh, S., Esmaeili, R., Fakhar, M., Fazaeli, A. A., Fischer, F., Foigt, N. A., Fukumoto, T., Fullman, N., Galan, A., Gamkrelidze, A., Gezae, K. E., Ghajar, A., Ghashghaee, A., Goginashvili, K., Haakenstad, A., Bidgoli, H. H., Hamidi, S., Harb, H. L., Hasanpoor, E., Hassen, H. Y., Hay, S. I., Hendrie, D., Henok, A., Heredia-Pi, I., Herteliu, C., Hoang, C. L., Hole, M. K., Rad, E. H., Hossain, N., Hosseinzadeh, M., Hostiuc, S., Ilesanmi, O. S., Irvani, S. S. N., Jakovljevic, M., Jalali, A., James, S. L., Jonas, J. B., JÃŒrisson, M., Kadel, R., Matin, B. K., Kasaeian, A., Kasaye, H. K., Kassaw, M. W., Karyani, A. K., Khabiri, R., Khan, J., Khan, M. N., Khang, Y. -H, Kisa, A., Kissimova-Skarbek, K., Kohler, S., Koyanagi, A., Krohn, K. J., Leung, R., Lim, L. -L, Lorkowski, S., Majeed, A., Malekzadeh, R., Mansourian, M., Mantovani, L. G., Massenburg, B. B., Mckee, M., Mehta, V., Meretoja, A., Meretoja, T. J., Kostova, N. M., Miller, T. R., Mirrakhimov, E. M., Mohajer, B., Darwesh, A. M., Mohammed, S., Mohebi, F., Mokdad, A. H., Morrison, S. D., Mousavi, S. M., Muthupandian, S., Nagarajan, A. J., Nangia, V., Negoi, I., Nguyen, C. T., Nguyen, H. L. T., Nguyen, S. H., Nosratnejad, S., Oladimeji, O., Olgiati, S., Olusanya, J. O., Onwujekwe, O. E., Otstavnov, S. S., Pana, A., Pereira, D. M., Piroozi, B., Prada, S. I., Qorbani, M., Rabiee, M., Rabiee, N., Rafiei, A., Rahim, F., Rahimi-Movaghar, V., Ram, U., Ranabhat, C. L., Ranta, A., Rawaf, D. L., Rawaf, S., Rezaei, S., Roro, E. M., Rostami, A., Rubino, S., Salahshoor, M., Samy, A. M., Sanabria, J., Santos, J. V., Milicevic, M. M. S., Jose, B. P. S., Savic, M., Schwendicke, F., Sepanlou, S. G., Sepehrimanesh, M., Sheikh, A., Shrime, M. G., Sisay, S., Soltani, S., Soofi, M., Srinivasan, V., TabarÃ©s-Seisdedos, R., Torre, A., Tovani-Palone, M. R., Tran, B. X., Tran, K. B., Undurraga, E. A., Valdez, P. R., Van Boven, J. F. M., Vargas, V., Veisani, Y., Violante, F. S., Vladimirov, S. K., Vlassov, V., Vollmer, S., Vu, G. T., Wolfe, C. D. A., Yonemoto, N., Younis, M. Z., Yousefifard, M., Zaman, S. B., Zangeneh, A., Zegeye, E. A., Ziapour, A., Chew, A., Murray, C. J. L., Dieleman, J. L., and Network, Global Burden of Disease Health Financing Collaborator
Abstract: Background: Comprehensive and comparable estimates of health spending in each country are a key input for health policy and planning, and are necessary to support the achievement of national and international health goals. Previous studies have tracked past and projected future health spending until 2040 and shown that, with economic development, countries tend to spend more on health per capita, with a decreasing share of spending from development assistance and out-of-pocket sources. We aimed to characterise the past, present, and predicted future of global health spending, with an emphasis on equity in spending across countries. Methods: We estimated domestic health spending for 195 countries and territories from 1995 to 2016, split into three categories-government, out-of-pocket, and prepaid private health spending-and estimated development assistance for health (DAH) from 1990 to 2018. We estimated future scenarios of health spending using an ensemble of linear mixed-effects models with time series specifications to project domestic health spending from 2017 through 2050 and DAH from 2019 through 2050. Data were extracted from a broad set of sources tracking health spending and revenue, and were standardised and converted to inflation-adjusted 2018 US dollars. Incomplete or low-quality data were modelled and uncertainty was estimated, leading to a complete data series of total, government, prepaid private, and out-of-pocket health spending, and DAH. Estimates are reported in 2018 US dollars, 2018 purchasing-power parity-adjusted dollars, and as a percentage of gross domestic product. We used demographic decomposition methods to assess a set of factors associated with changes in government health spending between 1995 and 2016 and to examine evidence to support the theory of the health financing transition. We projected two alternative future scenarios based on higher government health spending to assess the potential ability of governments to generate more reso
Published: 2019
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5. Health sector spending and spending on HIV/AIDS, tuberculosis, and malaria, and development assistance for health: progress towards Sustainable Development Goal 3

Author: Priya Rathi, Ritesh G. Menezes, Edris Hasanpoor, Sanni Yaya, Mohsen Bayati, Maciej Banach, Raffaele Palladino, Mikhail Sergeevich Zastrozhin, Siamak Sabour, Theo Vos, Tuomo J. Meretoja, Dimas Ria Angga Pribadi, Shahin Soltani, Simona Cătălina Ștefan, Behzad Karami Matin, Cyrus Alinia, Tudorel Andrei, Mehdi Bohluli, Nikita Otstavnov, Yanfang Su, Mohammad Ali Mansournia, Simon I. Hay, Mansour Ghafourifard, Songhomitra Panda-Jonas, Pushpendra Singh, Salman Rawaf, Morteza Arab-Zozani, Robert Ancuceanu, Samer Hamidi, Maarten J. Postma, Vijay Kumar Chattu, Ted R. Miller, Stanislav S. Otstavnov, Gbenga A. Kayode, Chhabi Lal Ranabhat, João Vasco Santos, Savita Lasrado, Jonathan F. Mosser, Chaw Yin Myint, Mihajlo Jakovljevic, Masoud Moghadaszadeh, Tanvir M. Huda, Fakher Rahim, Seyedeh Zahra Masoumi, Yingxi Zhao, Aziz Sheikh, Subramanian Senthilkumaran, Sheikh Mohammed Shariful Islam, Fariborz Mansour-Ghanaei, Andrew T Olagunju, Atif Amin Baig, Ali H. Mokdad, Anders Larsson, Atte Meretoja, Bach Xuan Tran, Lal B. Rawal, Brandon Cunningham, Vahid Alipour, Sowmya J. Rao, Anamika Pandey, Vahid Yazdi-Feyzabadi, Salime Goharinezhad, Angela E Micah, Leticia Avila-Burgos, Hayley N Stutzman, Farshad Farzadfar, M. Mofizul Islam, Sharareh Eskandarieh, Saqib Ali, Srikanta Banerjee, Zhi-Jiang Zhang, Anirudh Kotlo, Ravensara S. Travillian, Aziz Rezapour, Huong Lan Thi Nguyen, Sergio I. Prada, Biagio Simonetti, Maitreyi Sahu, Sadaf G. Sepanlou, Carlos A Castañeda-Orjuela, Hoa Thi Do, Farahnaz Joukar, Aso Mohammad Darwesh, Syed Mohamed Aljunid, Modhurima Moitra, In-Hwan Oh, Ayman Grada, Kenji Shibuya, Sojib Bin Zaman, Steven D Bachmeier, Hilda L Harb, Edson Serván-Mori, Bahram Mohajer, Van C. Lansingh, Ali Almasi, German Martinez, Till Bärnighausen, Reza Malekzadeh, Adam E. Berman, Matthew T. Schneider, Michael K. Hole, Reza Rawassizadeh, Bing-Fang Hwang, Bianca S. Zlavog, Mohammad Rabiee, Moses K. Muriithi, Anton C Harle, Mokhtar Mahdavi, Yohannes Kinfu, Olatunde Aremu, Cristiana Abbafati, Nelson Alvis-Guzman, Joseph L Dieleman, Lucero Cahuana-Hurtado, Abdollah Mohammadian-Hafshejani, Soewarta Kosen, Zeleke Hailemariam Abebo, Muge Cevik, Hassan Abolhassani, Farnam Mohebi, Job F M van Boven, Nataliya Foigt, Neda Milevska Kostova, Abdallah M. Samy, Roman Topor-Madry, Golsum Tsakalos, Benjamin B. Massenburg, Spencer L. James, Erkin M. Mirrakhimov, Miloje Savic, Mehdi Hosseinzadeh, Sawyer W Crosby, Ayesha Humayun, Hamidreza Setayesh, G Anil Kumar, Juan Sanabria, Jalal Arabloo, Milena M Santric Milicevic, Ai Koyanagi, Shokofeh Maleki, Junjie Wu, Nathaniel J Henry, Efat Mohamadi, Francesco Saverio Violante, Samad Azari, Delia Hendrie, Ahad Bakhtiari, Olayinka Stephen Ilesanmi, Pankaj Bhardwaj, Ahamarshan Jayaraman Nagarajan, Adnan Kisa, Masood Ali Shaikh, Shafiu Mohammed, Justice Nonvignon, Firooz Esmaeilzadeh, Eduardo A. Undurraga, Khurshid Alam, Muktar Beshir Ahmed, Mohamed M. Gad, Mikk Jürisson, Usman Iqbal, Chuanhua Yu, Luis Camera, Mohammad Ali Jahani, Abigail Chapin, Pascual R. Valdez, Reinhard Busse, Tomislav Mestrovic, Paul S. F. Yip, Christopher J L Murray, Jacob Olusegun Olusanya, Salah Eddin Karimi, Mustafa Z. Younis, Michael R.M. Abrigo, Rahul R. Zende, Mina Anjomshoa, Shane D. Morrison, Marcel Ausloos, Bruno Piassi Sao Jose, Zohre Javaheri, Saravanan Muthupandian, Valentin Yurievich Skryabin, Endalkachew Worku Mengesha, Lalit Dandona, Jacek Jerzy Jozwiak, Omar Mukhtar Salman, Rakhi Dandona, Mojtaba Bagherzadeh, Mostafa Dianatinasab, Reza Mohammadpourhodki, Seyed Sina Naghibi Irvani, Nancy Fullman, Claudiu Herteliu, Andreea Mirica, Jasvinder A. Singh, Amin Soheili, Lee Ling Lim, Charles D.A. Wolfe, Catalina Liliana Andrei, Ali Kazemi Karyani, Bolajoko O. Olusanya, Carl Abelardo T. Antonio, Tommi Vasankari, Jean Jacques Noubiap, Mehdi Naderi, Jagadish Rao Padubidri, Bernhard T. Baune, Navid Rabiee, Mark G. Shrime, Mayowa O. Owolabi, Lorenzo G. Mantovani, Desta Debalkie Atnafu, Vasily Vlassov, Kyle E. Simpson, Sorin Hostiuc, Shaun Wen Huey Lee, Cuong Tat Nguyen, Ian E Cogswell, Tesleem Kayode Babalola, Sanjay Basu, Hassan Haghparast Bidgoli, Leila Doshmangir, Marcos Roberto Tovani-Palone, Maha El Tantawi, Obinna Onwujekwe, Mohammad Ali Sahraian, Ahmed Omar Bali, Joshua A. Salomon, Hamidreza Komaki, David Laith Rawaf, Zoubida Zaidi, Hassan Magdy Abd El Razek, Reshmi Bhageerathy, Emilie R Maddison, Naohiro Yonemoto, Ahmad Ghashghaee, Asadollah Gholamian, Ferrán Catalá-López, Stefan Kohler, Rafael Tabarés-Seisdedos, Anwar Faraj, Rafael Lozano, Rufus Akinyemi, Florian Fischer, Jost B. Jonas, Dian Kusuma, Martin Amogre Ayanore, Rohollah Kalhor, Falk Schwendicke, Seyyed Meysam Mousavi, Micah, A. E., Su, Y., Bachmeier, S. D., Chapin, A., Cogswell, I. E., Crosby, S. W., Cunningham, B., Harle, A. C., Maddison, E. R., Moitra, M., Sahu, M., Schneider, M. T., Simpson, K. E., Stutzman, H. N., Tsakalos, G., Zende, R. R., Zlavog, B. S., Abbafati, C., Abebo, Z. H., Abolhassani, H., Abrigo, M. R. M., Ahmed, M. B., Akinyemi, R. O., Alam, K., Ali, S., Alinia, C., Alipour, V., Aljunid, S. M., Almasi, A., Alvis-Guzman, N., Ancuceanu, R., Andrei, T., Andrei, C. L., Anjomshoa, M., Antonio, C. A. T., Arabloo, J., Arab-Zozani, M., Aremu, O., Atnafu, D. D., Ausloos, M., Avila-Burgos, L., Ayanore, M. A., Azari, S., Babalola, T. K., Bagherzadeh, M., Baig, A. A., Bakhtiari, A., Banach, M., Banerjee, S. K., Barnighausen, T. W., Basu, S., Baune, B. T., Bayati, M., Berman, A. E., Bhageerathy, R., Bhardwaj, P., Bohluli, M., Busse, R., Cahuana-Hurtado, L., Camera, L. L. A., Castaneda-Orjuela, C. A., Catala-Lopez, F., Cevik, M., Chattu, V. K., Dandona, L., Dandona, R., Dianatinasab, M., Do, H. T., Doshmangir, L., El Tantawi, M., Eskandarieh, S., Esmaeilzadeh, F., Faraj, A., Farzadfar, F., Fischer, F., Foigt, N. A., Fullman, N., Gad, M. M., Ghafourifard, M., Ghashghaee, A., Gholamian, A., Goharinezhad, S., Grada, A., Haghparast Bidgoli, H., Hamidi, S., Harb, H. L., Hasanpoor, E., Hay, S. I., Hendrie, D., Henry, N. J., Herteliu, C., Hole, M. K., Hosseinzadeh, M., Hostiuc, S., Huda, T. M., Humayun, A., Hwang, B. -F., Ilesanmi, O. S., Iqbal, U., Irvani, S. S. N., Islam, S. M. S., Islam, M. M., Jahani, M. A., Jakovljevic, M., James, S. L., Javaheri, Z., Jonas, J. B., Joukar, F., Jozwiak, J. J., Jurisson, M., Kalhor, R., Karami Matin, B., Karimi, S. E., Kayode, G. A., Kazemi Karyani, A., Kinfu, Y., Kisa, A., Kohler, S., Komaki, H., Kosen, S., Kotlo, A., Koyanagi, A., Kumar, G. A., Kusuma, D., Lansingh, V. C., Larsson, A. O., Lasrado, S., Lee, S. W. H., Lim, L. -L., Lozano, R., Magdy Abd El Razek, H., Mahdavi, M. M., Maleki, S., Malekzadeh, R., Mansour-Ghanaei, F., Mansournia, M. A., Mantovani, L. G., Martinez, G., Masoumi, S. Z., Massenburg, B. B., Menezes, R. G., Mengesha, E. W., Meretoja, T. J., Meretoja, A., Mestrovic, T., Milevska Kostova, N., Miller, T. R., Mirica, A., Mirrakhimov, E. M., Moghadaszadeh, M., Mohajer, B., Mohamadi, E., Mohammad Darwesh, A., Mohammadian-Hafshejani, A., Mohammadpourhodki, R., Mohammed, S., Mohebi, F., Mokdad, A. H., Morrison, S. D., Mosser, J. F., Mousavi, S. M., Muriithi, M. K., Muthupandian, S., Myint, C. -Y., Naderi, M., Nagarajan, A. J., Nguyen, C. T., Nguyen, H. L. T., Nonvignon, J., Noubiap, J. J., Oh, I. -H., Olagunju, A. T., Olusanya, J. O., Olusanya, B. O., Omar Bali, A., Onwujekwe, O. E., Otstavnov, S. S., Otstavnov, N., Owolabi, M. O., Padubidri, J. R., Palladino, R., Panda-Jonas, S., Pandey, A., Postma, M. J., Prada, S. I., Pribadi, D. R. A., Rabiee, M., Rabiee, N., Rahim, F., Ranabhat, C. L., Rao, S. J., Rathi, P., Rawaf, S., Rawaf, D. L., Rawal, L., Rawassizadeh, R., Rezapour, A., Sabour, S., Sahraian, M. A., Salman, O. M., Salomon, J. A., Samy, A. M., Sanabria, J., Santos, J. V., Santric Milicevic, M. M., Sao Jose, B. 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School of Medicine, University of St Andrews. Infection and Global Health Division, Groningen Research Institute for Asthma and COPD (GRIAC), Value, Affordability and Sustainability (VALUE), and Real World Studies in PharmacoEpidemiology, -Genetics, -Economics and -Therapy (PEGET)
Subjects: Economic growth, Financing, Government, Psychological intervention, HIV Infections, burden of disease, 030204 cardiovascular system & hematology, DISEASE, ALLOCATION, 0302 clinical medicine, RA0421, RA0421 Public health. Hygiene. Preventive Medicine, Sustainable development, Global health, health economics, Healthcare Financing, HIV Infection, 030212 general & internal medicine, 10. No inequality, 11 Medical and Health Sciences, DALY, Healthy lives, 1. No poverty, Public Health, Global Health, Social Medicine and Epidemiology, 3rd-DAS, General Medicine, Sustainable Development, 3. Good health, tuberculosis, IMPOVERISHMENT, TERRITORIES, Financing, Human, Financing, Personal, Resource (biology), Tuberculosi, 195 COUNTRIES, Developing Countrie, 03 medical and health sciences, SDG 3 - Good Health and Well-being, Acquired immunodeficiency syndrome (AIDS), General & Internal Medicine, SYSTEMATIC ANALYSIS, medicine, Humans, Burden, HIV/AIDS, tubercolosis, malaria, Human resources, Developing Countries, Government, Acquired Immunodeficiency Syndrome, Health economics, business.industry, DISABILITY, CATASTROPHE, Global Burden of Disease Health Financing Collaborator Network, GLOBAL BURDEN, medicine.disease, Malaria, SDG, health sector spending, development assistant for health, Health Expenditure, Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi, 3121 General medicine, internal medicine and other clinical medicine, NA, Health Expenditures, business, EXPENDITURE
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 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. INTERPRETATION: 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. For complete list of authors see http://dx.doi.org/10.1016/S0140-6736(20)30608-5
Published: 2020

6. Measuring universal health coverage based on an index of effective coverage of health services in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019

Author: William M. Gardner, Rawlance Ndejjo, Govinda Prasad Dhungana, Fereshteh Ansari, Kathleen Pillsbury Hopf, João Pedro Silva, M. Mofizul Islam, Cong Zhu, Abdul Hafiz, Irmina Maria Michalek, Syed Mohamed Aljunid, Leonardo Roever, Mustefa Glagn, Davood Anvari, Tessa M. Pilz, Sameer Vali Gopalani, Joel M. Francis, Man Mohan Mehndiratta, Rakhi Dandona, Abbas Sheikhtaheri, Mansour Ghafourifard, Simon Øverland, David Laith Rawaf, Jaykaran Charan, Akram Pourshams, Mostafa Dianatinasab, Morteza Mahmoudi, Alton Lu, Alyssa N. Sbarra, Lorainne Tudor Car, Franz Castro, Hafiz Ansar Rasul Suleria, Luca Ronfani, Marina Pinheiro, Mehran Asadi-Aliabadi, Maziar Moradi-Lakeh, Hoa Thi Do, Whitney L. Teagle, Sofia Androudi, Carl Abelardo T. Antonio, Myron Anthony Godinho, Bhaskaran Unnikrishnan, Oluchi Ezekannagha, Getinet Ayano, Seyyed Shamsadin Athari, Dimas Ria Angga Pribadi, Kyle E. Simpson, Muluken Bekele Sorrie, Vivekanand Jha, Chukwuma David Umeokonkwo, Akshaya Srikanth Bhagavathula, Cuong Tat Nguyen, Amr Hassan, Akine Eshete Abosetugn, Hailay Abrha Gesesew, Anna V. Korotkova, Brijesh Sathian, Marcello Tonelli, Olatunde Aremu, Mohammad Reza Salahshoor, Juan Jesus Carrero, Cameron J. Kneib, Ravi Prakash Jha, David H. Shaw, Hossein Samadi Kafil, Tanuj Kanchan, Khezar Hayat, Hamid Sharifi, Morteza Shamsizadeh, Muktar Omer Omer, Fatemeh Amiri, Hamidreza Pazoki Toroudi, David Edvardsson, Xiu Ju George Zhao, Hannah Han, Leticia Avila-Burgos, Adam E. Berman, Jemal Abdu Mohammed, Thomas Pilgrim, Leila Doshmangir, Mu'awiyyah Babale Sufiyan, David M. Pigott, Hadi Hassankhani, Beatriz Paulina Ayala Quintanilla, Teklemariam Gultie, Arash Ziapour, Seyed Sina Naghibi Irvani, Ilse N. Dippenaar, Jean Jacques Noubiap, Emmanuela Gakidou, Abiyu Mekonnen Gebrehiwot, Maha El Tantawi, Xuefeng Liu, Zulfiqar A. Bhutta, Keyghobad Ghadiri, João Mauricio Castaldelli-Maia, Behzad Karami Matin, Yunquan Zhang, Vera Marisa Costa, Iyad Sultan, Mostafa Hosseini, Abdulaziz Khalid Abu Haimed, Haidong Wang, Kaleab Alemayehu Zewdie, Celine M. Barthelemy, Hosna Janjani, Bartosz Miazgowski, Jobert Richie Nansseu, Arianna Maever L. Amit, John S. Ji, Ata Rafiee, Maria Inês Schmidt, Alireza Rafiei, Somayeh Bohlouli, Joana Morgado-da-Costa, Huong Lan Thi Nguyen, Pradyumna Agasthi, Tiffany K. Gill, Martin McKee, Khaled Khatab, Jae Il Shin, Animut Tagele Tamiru, Giancarlo Logroscino, Hassan Abolhassani, Syed Saoud Zaidi, Sivan Yegnanarayana Iyer Saraswathy, Garumma Tolu Feyissa, Ahmad Daryani, Ziyad Al-Aly, Gebreamlak Gebremedhn Gebremeskel, Michael T. Chung, Amirhossein Sahebkar, Mehedi Hasan, Saeed Shahabi, Diep Ngoc Nguyen, Yohannes Kinfu, Nicholas L S Roberts, Jagadish Rao Padubidri, Mika Shigematsu, Lucero Cahuana-Hurtado, Deepa Jahagirdar, Islam Y. Elgendy, Erkin M. Mirrakhimov, Tanvir M. 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D., Soriano, Joan B, Sorrie, Muluken Bekele, Soyiri, Ireneous N, Spurlock, Emma Elizabeth, Sreeramareddy, Chandrashekhar T, Stanaway, Jeffrey D, Steel, Nichola, Stein, Caroline, Stokes, Mark A, Sufiyan, Mu'awiyyah Babale, Suleria, Hafiz Ansar Rasul, Sultan, Iyad, Szumowski, Łukasz, Tabarés-Seisdedos, Rafael, Tabuchi, Takahiro, Tadakamadla, Santosh Kumar, Taddele, Biruk Wogayehu, Tadesse, Degena Bahrey, Taherkhani, Amir, Tamiru, Animut Tagele, Tanser, Frank C, Tareque, Md Ismail, Tarigan, Ingan Ukur, Teagle, Whitney L, Tediosi, Fabrizio, Tefera, Yonas Getaye Getaye, Tela, Freweini Gebrearegay, Tessema, Zemenu Tadesse, Thakur, Bhaskar, Titova, Mariya Vladimirovna, Tonelli, Marcello, Topor-Madry, Roman, Topouzis, Foti, Tovani-Palone, Marcos Roberto Roberto, Tran, Bach Xuan, Travillian, Ravensara, Troeger, Christopher E, Tudor Car, Lorainne, Uddin, Riaz, Ullah, Irfan, Umeokonkwo, Chukwuma David, Unnikrishnan, Bhaskaran, Upadhyay, Era, Uthman, Olalekan A, Vacante, Marco, Valdez, Pascual R, Varughese, Santosh, Vasankari, Tommi Juhani, Vasseghian, Yasser, Venketasubramanian, Narayanaswamy, Violante, Francesco S, Vlassov, Vasily, Vollset, Stein Emil, Vongpradith, Avina, Vos, Theo, Waheed, Yasir, Walters, Magdalene K, Wamai, Richard G, Wang, Haidong, Wang, Yuan-Pang, Weintraub, Robert G, Weiss, Jordan, Werdecker, Andrea, Westerman, Ronny, Wilner, Lauren B, Woldu, Gebremariam, Wolfe, Charles D A, Wu, Ai-Min, Wulf Hanson, Sarah, Xie, Yang, Xu, Rixing, Yahyazadeh Jabbari, Seyed Hossein, Yamagishi, Kazumasa, Yano, Yuichiro, Yaya, Sanni, Yazdi-Feyzabadi, Vahid, Yearwood, Jamal A, Yeshitila, Yordanos Gizachew, Yip, Paul, Yonemoto, Naohiro, Younis, Mustafa Z, Yousefi, Zabihollah, Yousefinezhadi, Taraneh, Yusefzadeh, Hasan, Zadey, Siddhesh, Zahirian Moghadam, Telma, Zaidi, Syed Saoud, Zaki, Leila, Zaman, Sojib Bin, Zamani, Mohammad, Zamanian, Maryam, Zandian, Hamed, Zastrozhin, Mikhail Sergeevich, Zewdie, Kaleab Alemayehu, Zhang, Yunquan, Zhao, Xiu-Ju George, Zhao, Yingxi, Zheng, Peng, Zhu, Cong, Ziapour, Arash, Zlavog, Bianca S, Zodpey, Sanjay, Murray, Christopher J L, Lacey, B, Sartorius, B, Sálfræðideild (HR), Department of Psychology (RU), Samfélagssvið (HR), School of Social Sciences (RU), Háskólinn í Reykjavík, Reykjavik University, Lozano, R, Fullman, N, Mumford, J, Knight, M, Barthelemy, C, Abbafati, C, Abbastabar, H, Abd-Allah, F, Abdollahi, M, Abedi, A, Abolhassani, H, Abosetugn, A, Abreu, L, Abrigo, M, Abu Haimed, A, Abushouk, A, Adabi, M, Adebayo, O, Adekanmbi, V, Adelson, J, Adetokunboh, O, Adham, D, Advani, S, Afshin, A, Agarwal, G, Agasthi, P, Aghamir, S, Agrawal, A, Ahmad, T, Akinyemi, R, Alahdab, F, Al-Aly, Z, Alam, K, Albertson, S, Alemu, Y, Alhassan, R, Ali, M, Ali, S, Alipour, V, Aljunid, S, Alla, F, Almadi, M, Almasi, A, Almasi-Hashiani, A, Almasri, N, Al-Mekhlafi, H, Almulhim, A, Alonso, J, Al-Raddadi, R, Altirkawi, K, Alvis-Guzman, N, Alvis-Zakzuk, N, Amini, S, Amini-Rarani, M, Amiri, F, Amit, A, Amugsi, D, Ancuceanu, R, Anderlini, D, 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D, Briant, P, Briggs, A, Briko, N, Burugina Nagaraja, S, Busse, R, Butt, Z, Caetano dos Santos, F, Cahuana-Hurtado, L, Cámera, L, Cárdenas, R, Carreras, G, Carrero, J, Carvalho, F, Castaldelli-Maia, J, Castañeda-Orjuela, C, Castelpietra, G, Castro, F, Catalá-López, F, Causey, K, Cederroth, C, Cercy, K, Cerin, E, Chandan, J, Chang, A, Charan, J, Chattu, V, Chaturvedi, S, Chin, K, Cho, D, Choi, J, Christensen, H, Chu, D, Chung, M, Ciobanu, L, Cirillo, M, Comfort, H, Compton, K, Cortesi, P, Costa, V, Cousin, E, Dahlawi, S, Damiani, G, Dandona, L, Dandona, R, Darega Gela, J, Darwesh, A, Daryani, A, Dash, A, Davey, G, Dávila-Cervantes, C, Davletov, K, De Neve, J, Denova-Gutiérrez, E, Deribe, K, Dervenis, N, Desai, R, Dharmaratne, S, Dhungana, G, Dianatinasab, M, Dias da Silva, D, Diaz, D, Dippenaar, I, Do, H, Dorostkar, F, Doshmangir, L, Duncan, B, Duraes, A, Eagan, A, Edvardsson, D, El Sayed, I, El Tantawi, M, Elgendy, I, Elyazar, I, Eskandari, K, Eskandarieh, S, Esmaeilnejad, S, 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University, Health Sciences, 10922180 - Schutte, Aletta Elisabeth, Lozano, R., Fullman, N., Mumford, J. E., Knight, M., Barthelemy, C. M., Abbafati, C., Abbastabar, H., Abd-Allah, F., Abdollahi, M., Abedi, A., Abolhassani, H., Abosetugn, A. E., Abreu, L. G., Abrigo, M. R. M., Abu Haimed, A. K., Abushouk, A. I., Adabi, M., Adebayo, O. M., Adekanmbi, V., Adelson, J., Adetokunboh, O. O., Adham, D., Advani, S. M., Afshin, A., Agarwal, G., Agasthi, P., Aghamir, S. M. K., Agrawal, A., Ahmad, T., Akinyemi, R. O., Alahdab, F., Al-Aly, Z., Alam, K., Albertson, S. B., Alemu, Y. M., Alhassan, R. K., Ali, M., Ali, S., Alipour, V., Aljunid, S. M., Alla, F., Almadi, M. A. H., Almasi, A., Almasi-Hashiani, A., Almasri, N. A., Al-Mekhlafi, H. M., Almulhim, A. M., Alonso, J., Al-Raddadi, R. M., Altirkawi, K. A., Alvis-Guzman, N., Alvis-Zakzuk, N. J., Amini, S., Amini-Rarani, M., Amiri, F., Amit, A. M. L., Amugsi, D. A., Ancuceanu, R., Anderlini, D., Andrei, C. L., Androudi, S., Ansari, F., Ansari-Moghaddam, A., Antonio, C. A. T., Antony, C. 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Subjects: Index (economics), Servicios de Salud, SUSTAINABLE DEVELOPMENT GOALS, 030204 cardiovascular system & hematology, universal health coverage, sustaibale develpment goal, global burden of disease, performance, systematic analysis, Global Burden of Disease, 0302 clinical medicine, Universal Health Insurance, RA0421, 11. Sustainability, Per capita, Medical economics, Disease, 030212 general & internal medicine, 10. No inequality, 11 Medical and Health Sciences, effective coverage of health services, GBD 2019 Universal Health Coverage Collaborators, education.field_of_study, Public health, Medical care, Sjúkdómar, 4. Education, 1. No poverty, Health coverage, Public Health, Global Health, Social Medicine and Epidemiology, General Medicine, Hälsovetenskaper, 3142 Public health care science, environmental and occupational health, Health services, 3. Good health, Global burden of disease, Health Expenditures, Humans, World Health Organization, Purchasing power parity, Scale (social sciences), Lýðheilsa, universal health coverag, CANCER SURVIVAL, ACCESS, Human, Heilsuhagfræði, medicine.medical_specialty, Health coverage, GBD, GBD, Universal health, GBD 2019, Population, Health expenditures, 3122 Cancers, Population health, 03 medical and health sciences, Health systems, Heilbrigðisvísindi, SDG 3 - Good Health and Well-being, General & Internal Medicine, Development economics, Health Sciences, medicine, Heilbrigðisstefna, Alþjóðaheilbrigðisstofnunin, QUALITY, Global Burden of Disease Study, education, PROGRESS, Disease burden, Health services accessibility, CARE, Heilbrigðisþjónusta, purl.org/pe-repo/ocde/ford#3.02.00 [https], Health Expenditure, Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi, 3121 General medicine, internal medicine and other clinical medicine, Morbility, Administración de los Servicios de Salud, Medical policy, Business, Heilbrigðiskerfi
Abstract: Publisher's version (útgefin grein), Background Achieving universal health coverage (UHC) involves all people receiving the health services they need, of high quality, without experiencing financial hardship. Making progress towards UHC is a policy priority for both countries and global institutions, as highlighted by the agenda of the UN Sustainable Development Goals (SDGs) and WHO's Thirteenth General Programme of Work (GPW13). Measuring effective coverage at the health-system level is important for understanding whether health services are aligned with countries' health profiles and are of sufficient quality to produce health gains for populations of all ages. Methods Based on the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, we assessed UHC effective coverage for 204 countries and territories from 1990 to 2019. Drawing from a measurement framework developed through WHO's GPW13 consultation, we mapped 23 effective coverage indicators to a matrix representing health service types (eg, promotion, prevention, and treatment) and five population-age groups spanning from reproductive and newborn to older adults (>= 65 years). Effective coverage indicators were based on intervention coverage or outcome-based measures such as mortality-to-incidence ratios to approximate access to quality care; outcome-based measures were transformed to values on a scale of 0-100 based on the 2.5th and 97.5th percentile of location-year values. We constructed the UHC effective coverage index by weighting each effective coverage indicator relative to its associated potential health gains, as measured by disability-adjusted life-years for each location-year and population-age group. For three tests of validity (content, known-groups, and convergent), UHC effective coverage index performance was generally better than that of other UHC service coverage indices from WHO (ie, the current metric for SDG indicator 3.8.1 on UHC service coverage), the World Bank, and GBD 2017. We quantified frontiers of UHC effective coverage performance on the basis of pooled health spending per capita, representing UHC effective coverage index levels achieved in 2019 relative to country-level government health spending, prepaid private expenditures, and development assistance for health. To assess current trajectories towards the GPW13 UHC billion target-1 billion more people benefiting from UHC by 2023-we estimated additional population equivalents with UHC effective coverage from 2018 to 2023. Findings Globally, performance on the UHC effective coverage index improved from 45.8 (95% uncertainty interval 44.2-47.5) in 1990 to 60.3 (58.7-61.9) in 2019, yet country-level UHC effective coverage in 2019 still spanned from 95 or higher in Japan and Iceland to lower than 25 in Somalia and the Central African Republic. Since 2010, sub-Saharan Africa showed accelerated gains on the UHC effective coverage index (at an average increase of 2.6% [1.9-3.3] per year up to 2019); by contrast, most other GBD super-regions had slowed rates of progress in 2010-2019 relative to 1990-2010. Many countries showed lagging performance on effective coverage indicators for non-communicable diseases relative to those for communicable diseases and maternal and child health, despite non-communicable diseases accounting for a greater proportion of potential health gains in 2019, suggesting that many health systems are not keeping pace with the rising non-communicable disease burden and associated population health needs. In 2019, the UHC effective coverage index was associated with pooled health spending per capita (r=0.79), although countries across the development spectrum had much lower UHC effective coverage than is potentially achievable relative to their health spending. Under maximum efficiency of translating health spending into UHC effective coverage performance, countries would need to reach $1398 pooled health spending per capita (US$ adjusted for purchasing power parity) in order to achieve 80 on the UHC effective coverage index. From 2018 to 2023, an estimated 388.9 million (358.6-421.3) more population equivalents would have UHC effective coverage, falling well short of the GPW13 target of 1 billion more people benefiting from UHC during this time. Current projections point to an estimated 3.1 billion (3.0-3.2) population equivalents still lacking UHC effective coverage in 2023, with nearly a third (968.1 million [903.5-1040.3]) residing in south Asia. Interpretation The present study demonstrates the utility of measuring effective coverage and its role in supporting improved health outcomes for all people-the ultimate goal of UHC and its achievement. Global ambitions to accelerate progress on UHC service coverage are increasingly unlikely unless concerted action on non-communicable diseases occurs and countries can better translate health spending into improved performance. Focusing on effective coverage and accounting for the world's evolving health needs lays the groundwork for better understanding how close-or how far-all populations are in benefiting from UHC., Lucas Guimaraes Abreu acknowledges support from Coordenacao de Aperfeicoamento de Pessoal de Nivel Superior -Brasil (Capes) -Finance Code 001, Conselho Nacional de Desenvolvimento Cientifico e Tecnologico (CNPq) and Fundacao de Amparo a Pesquisa do Estado de Minas Gerais (FAPEMIG). Olatunji O Adetokunboh acknowledges South African Department of Science & Innovation, and National Research Foundation. Anurag Agrawal acknowledges support from the Wellcome Trust DBT India Alliance Senior Fellowship IA/CPHS/14/1/501489. Rufus Olusola Akinyemi acknowledges Grant U01HG010273 from the National Institutes of Health (NIH) as part of the H3Africa Consortium. Rufus Olusola Akinyemi is further supported by the FLAIR fellowship funded by the UK Royal Society and the African Academy of Sciences. Syed Mohamed Aljunid acknowledges the Department of Health Policy and Management, Faculty of Public Health, Kuwait University and International Centre for Casemix and Clinical Coding, Faculty of Medicine, National University of Malaysia for the approval and support to participate in this research project. Marcel Ausloos, Claudiu Herteliu, and Adrian Pana acknowledge partial support by a grant of the Romanian National Authority for Scientific Research and Innovation, CNDSUEFISCDI, project number PN-III-P4-ID-PCCF-2016-0084. Till Winfried Barnighausen acknowledges support from the Alexander von Humboldt Foundation through the Alexander von Humboldt Professor award, funded by the German Federal Ministry of Education and Research. Juan J Carrero was supported by the Swedish Research Council (2019-01059). Felix Carvalho acknowledges UID/MULTI/04378/2019 and UID/QUI/50006/2019 support with funding from FCT/MCTES through national funds. Vera Marisa Costa acknowledges support from grant (SFRH/BHD/110001/2015), received by Portuguese national funds through Fundacao para a Ciencia e a Tecnologia (FCT), IP, under the Norma TransitA3ria DL57/2016/CP1334/CT0006. Jan-Walter De Neve acknowledges support from the Alexander von Humboldt Foundation. Kebede Deribe acknowledges support by Wellcome Trust grant number 201900/Z/16/Z as part of his International Intermediate Fellowship. Claudiu Herteliu acknowledges partial support by a grant co-funded by European Fund for Regional Development through Operational Program for Competitiveness, Project ID P_40_382. Praveen Hoogar acknowledges the Centre for Bio Cultural Studies (CBiCS), Manipal Academy of Higher Education(MAHE), Manipal and Centre for Holistic Development and Research (CHDR), Kalghatgi. Bing-Fang Hwang acknowledges support from China Medical University (CMU108-MF-95), Taichung, Taiwan. Mihajlo Jakovljevic acknowledges the Serbian part of this GBD contribution was co-funded through the Grant OI175014 of the Ministry of Education Science and Technological Development of the Republic of Serbia. Aruna M Kamath acknowledges funding from the National Institutes of Health T32 grant (T32GM086270). Srinivasa Vittal Katikireddi acknowledges funding from the Medical Research Council (MC_UU_12017/13 & MC_UU_12017/15), Scottish Government Chief Scientist Office (SPHSU13 & SPHSU15) and an NRS Senior Clinical Fellowship (SCAF/15/02). Yun Jin Kim acknowledges support from the Research Management Centre, Xiamen University Malaysia (XMUMRF/2018-C2/ITCM/0001). Kewal Krishan acknowledges support from the DST PURSE grant and UGC Center of Advanced Study (CAS II) awarded to the Department of Anthropology, Panjab University, Chandigarh, India. Manasi Kumar acknowledges support from K43 TW010716 Fogarty International Center/NIMH. Ben Lacey acknowledges support from the NIHR Oxford Biomedical Research Centre and the BHF Centre of Research Excellence, Oxford. Ivan Landires is a member of the Sistema Nacional de InvestigaciA3n (SNI), which is supported by the Secretaria Nacional de Ciencia Tecnologia e Innovacion (SENACYT), Panama. Jeffrey V Lazarus acknowledges support by a Spanish Ministry of Science, Innovation and Universities Miguel Servet grant (Instituto de Salud Carlos III/ESF, European Union [CP18/00074]). Peter T N Memiah acknowledges CODESRIA; HISTP. Subas Neupane acknowledges partial support from the Competitive State Research Financing of the Expert Responsibility area of Tampere University Hospital. Shuhei Nomura acknowledges support from the Ministry of Education, Culture, Sports, Science, and Technology of Japan (18K10082). Alberto Ortiz acknowledges support by ISCIII PI19/00815, DTS18/00032, ISCIII-RETIC REDinREN RD016/0009 Fondos FEDER, FRIAT, Comunidad de Madrid B2017/BMD-3686 CIFRA2-CM. These funding sources had no role in the writing of the manuscript or the decision to submit it for publication. George C Patton acknowledges support from a National Health & Medical Research Council Fellowship. Marina Pinheiro acknowledges support from FCT for funding through program DL 57/2016 -Norma transitA3ria. Alberto Raggi, David Sattin, and Silvia Schiavolin acknowledge support by a grant from the Italian Ministry of Health (Ricerca Corrente, Fondazione Istituto Neurologico C Besta, Linea 4 -Outcome Research: dagli Indicatori alle Raccomandazioni Cliniche). Daniel Cury Ribeiro acknowledges support from the Sir Charles Hercus Health Research Fellowship -Health Research Council of New Zealand (18/111). Perminder S Sachdev acknowledges funding from the NHMRC Australia. Abdallah M Samy acknowledges support from a fellowship from the Egyptian Fulbright Mission Program. Milena M Santric-Milicevic acknowledges support from the Ministry of Education, Science and Technological Development of the Republic of Serbia (Contract No. 175087). Rodrigo Sarmiento-Suarez acknowledges institutional support from University of Applied and Environmental Sciences in Bogota, Colombia, and Carlos III Institute of Health in Madrid, Spain. Maria Ines Schmidt acknowledges grants from the Foundation for the Support of Research of the State of Rio Grande do Sul (IATS and PrInt) and the Brazilian Ministry of Health. Sheikh Mohammed Shariful Islam acknowledges a fellowship from the National Heart Foundation of Australia and Deakin University. Aziz Sheikh acknowledges support from Health Data Research UK. Kenji Shibuya acknowledges Japan Ministry of Education, Culture, Sports, Science and Technology. Joan B Soriano acknowledges support by Centro de Investigacion en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII), Madrid, Spain. Rafael Tabares-Seisdedos acknowledges partial support from grant PI17/00719 from ISCIII-FEDER. Santosh Kumar Tadakamadla acknowledges support from the National Health and Medical Research Council Early Career Fellowship, Australia. Marcello Tonelli acknowledges the David Freeze Chair in Health Services Research at the University of Calgary, AB, Canada., "Peer Reviewed"
Published: 2020

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6. Measuring universal health coverage based on an index of effective coverage of health services in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019

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