The Lancet Number 10252 | Sep 05, 2020
Summary
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.
Funding The Bill & Melinda Gates Foundation.
Copyright © 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license
