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February 22, 2019

Countries spending more on health as external finance declines

Islamabad

February 22, 2019

Islamabad : A report released by the World Health Organisation (WHO) reveals a swift upward trajectory of global health spending, particularly in low- and middle-income countries where health spending is growing on an annual average of 6% compared to 4% in high-income countries.

Titled ‘Public Spending on Health: A Closer Look at Global Trends,’ the 2018 global health financing report presents health spending data for all WHO Member States between 2000 and 2016. It shows a transformation trajectory for global spending on health, with increasing domestic public funding and declining external financing. The report also presents, for the first time, spending on primary healthcare and specific diseases, and looks closely at the relationship between spending and service coverage

Spending on health is growing faster than the rest of the global economy, accounting for 10% of global gross domestic product (GDP), the report informs. Health spending is made up of government expenditure, out-of-pocket payments (people paying for their own care), and sources such as voluntary health insurance, employer-provided health programmes, and activities by non-governmental organisations. Governments provide an average of 51% of a country’s health spending, while more than 35% of health spending per country comes from out-of-pocket expenses. One consequence of this is 100 million people pushed into extreme poverty each year.

The report highlights a trend of increasing domestic public funding for health in low- and middle-income countries and declining external funding in middle-income countries. Reliance on out-of-pocket expenses is declining around the world, albeit slowly.

I”n middle-income countries, government health expenditure per capita has doubled since the year 2000.

On average, governments spend $60 per person on health in lower-middle income countries and close to $270 per person in upper-middle income countries. When government spending on health increases, people are less likely to fall into poverty seeking health services. But government spending only reduces inequities in access when allocations are carefully planned to ensure that the entire population can obtain primary health care,” the report states.

In low- and middle-income countries, new data suggest that more than half of health spending is devoted to primary health care. Yet less than 40% of all spending on primary health care comes from governments. The report also examines the role of external funding. As domestic spending increases, the proportion of funding provided by external aid has dropped to less than 1% of global health expenditure. Almost half of these external funds are devoted to three diseases – HIV/AIDS, Tuberculosis (TB) and malaria.

The report points to ways that policy makers, health professionals and citizens alike can continue to strengthen health systems. It confirms the transformation of the world’s funding of health services and the centrality of domestic spending on health to universal health coverage. However, at the same time, there is no clear trend of increased government priority for health. The report also labels

primary health care as being a priority for expenditure tracking, and maintains that allocations across disease and interventions differ between external and government sources. One of its conclusions is that the performance of government spending on health can improve.

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