Spending on health & HIV/AIDS:domestic health spending & development assistance

[John Short]

Useful article for anyone carrying out a Health/HIV AIDS PER
by Global Burden of Disease Health Financing Collaborator Network
The Lancet Vol.391 | Number 10130 | Apr 21, 2018

Summary Background Comparable estimates of health spending are crucial for the assessment of health systems and to optimally deploy health resources. The methods used to track health spending continue to evolve, but little is known about the distribution of spending across diseases. We developed improved estimates of health spending by source, including development assistance for health, and, for the first time, estimated HIV/AIDS spending on prevention and treatment and by source of funding, for 188 countries.
Methods We collected published data on domestic health spending, from 1995 to 2015, from a diverse set of international agencies. We tracked development assistance for health from 1990 to 2017. We also extracted 5385 datapoints about HIV/AIDS spending, between 2000 and 2015, from online databases, country reports, and proposals submitted to multilateral organisations. We used spatiotemporal Gaussian process regression to generate complete and comparable estimates for health and HIV/AIDS spending. We report most estimates in 2017 purchasing power parity-adjusted dollars and adjust all estimates for the effect of inflation.
Findings Between 1995 and 2015, global health spending per capita grew at an annualised rate of 3·1% (95% uncertainty interval [UI] 3·1 to 3·2), with growth being largest in upper-middle-income countries (5·4% per capita [UI 5·3–5·5]) and lower-middle-income countries (4·2% per capita [4·2–4·3]). In 2015, $9·7 trillion (9·7 trillion to 9·8 trillion) was spent on health worldwide. High-income countries spent $6·5 trillion (6·4 trillion to 6·5 trillion) or 66·3% (66·0 to 66·5) of the total in 2015, whereas low-income countries spent $70·3 billion (69·3 billion to 71·3 billion) or 0·7% (0·7 to 0·7). Between 1990 and 2017, development assistance for health increased by 394·7% ($29·9 billion), with an estimated $37·4 billion of development assistance being disbursed for health in 2017, of which $9·1 billion (24·2%) targeted HIV/AIDS. Between 2000 and 2015, $562·6 billion (531·1 billion to 621·9 billion) was spent on HIV/AIDS worldwide. Governments financed 57·6% (52·0 to 60·8) of that total. Global HIV/AIDS spending peaked at 49·7 billion (46·2–54·7) in 2013, decreasing to $48·9 billion (45·2 billion to 54·2 billion) in 2015. That year, low-income and lower-middle-income countries represented 74·6% of all HIV/AIDS disability-adjusted life-years, but just 36·6% (34·4 to 38·7) of total HIV/AIDS spending. In 2015, $9·3 billion (8·5 billion to 10·4 billion) or 19·0% (17·6 to 20·6) of HIV/AIDS financing was spent on prevention, and $27·3 billion (24·5 billion to 31·1 billion) or 55·8% (53·3 to 57·9) was dedicated to care and treatment.
Interpretation From 1995 to 2015, total health spending increased worldwide, with the fastest per capita growth in middle-income countries. While these national disparities are relatively well known, low-income countries spent less per person on health and HIV/AIDS than did high-income and middle-income countries. Furthermore, declines in development assistance for health continue, including for HIV/AIDS. Additional cuts to development assistance could hasten this decline, and risk slowing progress towards global and national goals.
Funding The Bill & Melinda Gates Foundation.
Copyright © 2018 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license

Attached also is a HIV/AIDS PER for Kenya 2005

[John Short]

Trends in future health financing and coverage: future health
spending and universal health coverage in 188 countries,
2016–40
Global Burden of Disease Health Financing Collaborator Network

A follow up article from the Lancet

Methods We extracted historical data on gross domestic product (GDP) and health spending for 188 countries from
1995 to 2015, and projected annual GDP, development assistance for health, and government, out-of-pocket, and
prepaid private health spending from 2015 through to 2040 as a reference scenario. These estimates were generated
using an ensemble of models that varied key demographic and socioeconomic determinants. We generated better
and worse alternative future scenarios based on the global distribution of historic health spending growth rates. Last,
we used stochastic frontier analysis to investigate the association between pooled health resources and UHC index, a
measure of a country’s UHC service coverage. Finally, we estimated future UHC performance and the number of
people covered under the three future scenarios.
Findings In the reference scenario, global health spending was projected to increase from US$10 trillion
(95% uncertainty interval 10 trillion to 10 trillion) in 2015 to $20 trillion (18 trillion to 22 trillion) in 2040. Per capita
health spending was projected to increase fastest in upper-middle-income countries, at 4·2% (3·4–5·1) per year,
followed by lower-middle-income countries (4·0%, 3·6–4·5) and low-income countries (2·2%, 1·7–2·8). Despite
global growth, per capita health spending was projected to range from only $40 (24–65) to $413 (263–668) in 2040 in
low-income countries, and from $140 (90–200) to $1699 (711–3423) in lower-middle-income countries. Globally, the
share of health spending covered by pooled resources would range widely, from 19·8% (10·3–38·6) in Nigeria to
97·9% (96·4–98·5) in Seychelles. Historical performance on the UHC index was significantly associated with pooled
resources per capita. Across the alternative scenarios, we estimate UHC reaching between 5·1 billion (4·9 billion to
5·3 billion) and 5·6 billion (5·3 billion to 5·8 billion) lives in 2030.
Interpretation We chart future scenarios for health spending and its relationship with UHC. Ensuring that all
countries have sustainable pooled health resources is crucial to the achievement of UHC.
Funding The Bill & Melinda Gates Foundation.
Copyright © 2018 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.