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Global Spending on Health GLOBAL REPORT Global spending on health: Weathering the storm 2020 B • Before COVID-19 hit the world Global Spending on Health: Weathering the storm Global spending on health 2020: weathering the storm ISBN 978-92-4-001778-8 (electronic version) ISBN 978-92-4-001779-5 (print version) © World Health Organization 2020 Some rights reserved. This work is available under the Creative Commons Attribution-NonCommercial-ShareA- like 3.0 IGO licence (CC BY-NC-SA 3.0 IGO; https://creativecommons.org/licenses/by-nc-sa/3.0/igo). Under the terms of this licence, you may copy, redistribute and adapt the work for non-commercial purposes, provided the work is appropriately cited, as indicated below. In any use of this work, there should be no sugges- tion that WHO endorses any specific organization, products or services. The use of the WHO logo is not permit- ted. If you adapt the work, then you must license your work under the same or equivalent Creative Commons licence. If you create a translation of this work, you should add the following disclaimer along with the suggested citation: “This translation was not created by the World Health Organization (WHO). WHO is not responsible for the content or accuracy of this translation. The original English edition shall be the binding and authentic edition”. Any mediation relating to disputes arising under the licence shall be conducted in accordance with the mediation rules of the World Intellectual Property Organization (http://www.wipo.int/amc/en/mediation/rules/). Suggested citation. Global spending on health 2020: weathering the storm. Geneva: World Health Organization; 2020. Licence: CC BY-NC-SA 3.0 IGO. Cataloguing-in-Publication (CIP) data. CIP data are available at http://apps.who.int/iris. Sales, rights and licensing. To purchase WHO publications, see http://apps.who.int/bookorders. To submit requests for commercial use and queries on rights and licensing, see http://www.who.int/about/licensing. Third-party materials. If you wish to reuse material from this work that is attributed to a third party, such as tables, figures or images, it is your responsibility to determine whether permission is needed for that reuse and to obtain permission from the copyright holder. The risk of claims resulting from infringement of any third- party- owned component in the work rests solely with the user. General disclaimers. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of WHO concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted and dashed lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by WHO in preference to others of a similar nature that are not mentioned. Errors and omis- sions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by WHO to verify the information contained in this publication. How- ever, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall WHO be liable for damages arising from its use. Photo credit: Cover photo © Lane Pearman. Reproduced and adapted, with addition of line drawings, under cre- ative commons licence CC BY 2.0 (https://creativecommons.org/licenses/by/2.0/). Contents Acknowledgements v Abbreviations vii Key messages ix CHAPTER 1 Before COVID-19 hit the world: Global spending on health was growing 1 CHAPTER 2 Spending across diseases: Differences between low and middle income countries 19 CHAPTER 3 No country left behind: Can lower income countries increase health spending? 35 CHAPTER 4 COVID-19: Near- and medium-term implications for health spending 53 CHAPTER 5 Weathering the storm: Charting a new course towards the Sustainable Development Goal for health 73 Annexes 79 Acknowledgements This report is the product of the collective effort of many peo- Thanks also go to the consultants that helped countries in ple around the world, led by the Health Expenditure Tracking preparing the data for the 2020 update of the Global Health team in WHO Headquarters in Geneva and with important Expenditure Database: Jean-Edouard Doamba, Evgeniy Dol- contributions from staff of the World Bank, the Global gikh, Fe Vida N Dy-Liacco, Lachlan McDonald, Mahmoud Financing Facility and the Organization for Economic Cooper- Farag, Consulting Group Curatio Sarl led by David Gzirishvili, ation and Development. Kieu Huu Hanh, Eunkyoung Kim, Eddy Mongani Mpotongwe, The core writing team of the report includes Ke Xu, Agnès Simon Nassa, Anastasiya Nitsoy, Daniel Osei, Ezrah Rwak- Soucat, Joseph Kutzin, Julien Dupuy, Andrew Siroka, Natalja inanga, Shakthivel Selvaraj, Katerina Sharapka, Neil Thala- Eigo, Susan Sparkes, Hapsatou Touré, Maria Aranguren Gar- gala and Thongleck Xiong. cia, Hélène Barroy, Chandika Indikadahena, Matthew Jowett We also wish to recognize the contributions to data quality and Ajay Tandon. Marion Cros, Gabriela Flores, Benjamin improvement made by numerous World Bank staff, as well Lane, Wendy Li, Federica Margini, Ange Mibindzou Mouelet, as the collaboration provided through the P4H network and Michael Mueller and David Morgan also contributed valuable UHC2030. Our ongoing collaboration with the OECD Health written inputs. Accounts Team and Eurostat, as well as with the European We are grateful for the contributions of numerous individ- Observatory on Health Systems and Policies, has played a uals and agencies for their support in making this report pos- key role in ensuring the routine production and appropriate sible, for their contributions to comments and suggestions in categorization of health expenditure data from most high- producing this report and for their efforts in improving the income countries. quality and completeness of the data that form the basis of Most important of all, we express our appreciation to the this report. From the WHO Global Health Financing Team country Health Accounts teams and the strong support pro- across all levels of the Organization, these include Baktygul vided by the Ministries of Health of the Member States. Akkazieva, Camilo Cid, Gregory Coudrier, Seydou Coulibaly, We would like to thank the Bill & Melinda Gates Founda- Peter Cowley, Ilker Dastan, Valeria De Oliveira Cruz, Tamás tion; the Global Fund to Fight AIDS, Tuberculosis and Malaria; Evetovits, Triin Habicht, Gael Kernen, Awad Mataria, Diane Gavi Alliance; United States Agency for International Devel- Muhongerwa, Juliet Nabyonga, Benjamin Nganda, Claudia opment; the Department for International Development of Pescetto, Tomaš Roubal, Ding Wang and Hui Wang. From the United Kingdom; the European Commission; the Govern- WHO Technical Departments, Sean Cockerham, Kaia Eng- ment of Japan; the Government of the French Republic; and esveen, Ines Garcia Baena, Veloshnee Govender, Xiao-Xian the Government of the Grand Duchy of Luxembourg for their Huang, Nathalie Vande Maele and Temo Waqanivalu. funding support to WHO’s health financing work, which has We are also grateful for the contributions of Patricia Her- played a critical role in enabling us to make health expendi- nandez and Karin Vrijburg from the Netherlands Interdisci- ture tracking data, and the analysis of these data, a valuable plinary Demographic Institute, as well as Patrick Hoang-Vu global public good. Eozenou and Jewelwayne Salcedo Cain of the World Bank, Thanks go as well to a team at Communications Develop- and to Cor van Mosseveld who provided valuable inputs for ment—led by Bruce Ross-Larson and including Joe Brinley, the report. Joe Caponio, Mike Crumplar, Elaine Wilson and Debra Naylor—for editing and laying out the report. v Abbreviations AFR WHO African Region AMR WHO Region of the Americas CGH Common goods for health CVA Cash and voucher assistance EMR WHO Eastern Mediterranean Region EU European Union EUR WHO European Region EXT External aid GDP Gross Domestic Product GFF Global Financing Facility GGE General government expenditure GGHED Domestic public spending HICs High income countries HIV Human Immunodeficiency Virus IDs Infectious diseases IMF International Monetary Fund LICs Low income countries LMICs Lower middle income countries MDG Millennium Development Goals MICs Middle income countries NCDs Noncommunicable diseases NHA National Health Accounts NTDs Neglected tropical diseases ODA Official development assistance OECD Organisation for Economic Co-Operation and Development OOPS Out-of-pocket spending PHC Primary health care PPP Purchasing power parity PVTD Domestic private spending SEAR WHO South-East Asian Region SDG Sustainable Development Goals SHA System of Health Accounts TB Tuberculosis UHC Universal health coverage UMICs Upper middle income countries WHO World Health Organization WPR WHO Western Pacific Region vii Key messages Before the COVID-19 pandemic, global spending on health was continuing to rise, though at a slower rate in recent years • In 2018, global spending on health reached US$ 8.3 trillion, or 10% of global GDP, and it was the first time in the past five years that health spending grew slower than GDP. • Government health spending per capita grew over the 2000–2018
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