Challenging road ahead for universal health care in low- and middle-income countries

Community health workers in Ethiopia. File 2011. (Credit: USAID)

Despite donors’ investments in global health, there are huge disparities in health spending across the world. On average, for every dollar of health spending in high-income countries, low-income countries spend three cents.* By 2040, new research estimates that these disparities will persist, and millions may remain in need of basic health services in poor countries.

In a study published today in The Lancet, Dr. Joseph Dieleman at the Institute for Health Metrics and Evaluation (IHME) and colleagues estimate that only half of governments in low- and middle-income countries will meet the $86 per person spending target recommended by Chatham House to provide access to primary care. Chatham House also set another target for governments to spend 5 percent of GDP on health to prevent people from being pushed over the poverty line from health expenses. By 2040, the researchers estimate that just one low-income country (Rwanda) and roughly a third of middle-income countries (36 of 98) would meet this goal.

By 2040, the study found that low-income countries are on track to spend the same amount on health per person as high-income countries did 50 years ago.

These findings underscore the importance of continued global health funding from donors, which is stagnating. IHME’s latest Financing Global Health report estimates that development assistance for health barely increased from 2014 and 2015 after tripling between 2000 and 2010. You can explore these trends in the newly updated version of the Financing Global Health data visualization tool on IHME’s website.

Development assistance for health by channel, 1990-2015

financing global health chart 1

Note: This graph comes from the Financing Global Health visualization, available at http://vizhub.healthdata.org/fgh/. The findings come from the following study published in The Lancet on April 13, 2016, “Development assistance for health: past trends, associations, and the future of international financial flows for health.”

“For low- and middle-income countries to reach international spending targets and close the gap, domestic and international health funding will need to increase beyond historical growth rates,” said Dieleman. “In low-income countries, on average $0.71 of international aid is provided for every $1 of domestic government funding, making it a critical resource.”

Donor funding makes up large portions of health budgets in many countries in sub-Saharan Africa in particular, as shown in the map.

Development assistance for health/government health expenditure financed by taxpayers, 2013

Note: This graph comes from the Financing Global Health visualization, available at http://vizhub.healthdata.org/fgh/. The findings come from the following study published in The Lancet on April 13, 2016, “Development assistance for health: past trends, associations, and the future of international financial flows for health.”

Note: This graph comes from the Financing Global Health visualization, available at http://vizhub.healthdata.org/fgh/. The findings come from the following study published in The Lancet on April 13, 2016, “Development assistance for health: past trends, associations, and the future of international financial flows for health.”

Mobilizing additional support from donors will be crucial for addressing the health financing gap in low- and middle-income countries, as will better targeting limited resources to maximize health gains.

In a comment on the study, Tim Evans at the World Bank, and Ariel Pablos-Méndez at the U.S. Agency for International Development, wrote “Prohealth subsidies targeted to the poor, such as conditional cash transfers, should be promoted, whereas ineffective subsidies (e.g., for fuel), which can exceed a country’s spending on health, should be eliminated… [Also] an urgent need exists for innovations that direct private expenditure into prepaid pools; for example, through expansion of social health insurance towards informal sector workers and their families.”

*These disparities remain even after adjusting for purchasing power.

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About Author

Katie Leach-Kemon

Katherine (Katie) Leach-Kemon is a policy translation specialist at the Institute for Health Metrics and Evaluation (IHME). Katie specializes in two of IHME's research areas, the Global Burden of Disease and health financing. Katie has helped produce IHME's Financing Global Health report since it was first published in 2009. She received an MPH from the University of Washington and served as a Peace Corps volunteer in Niger. Her work has been published in The Lancet, Health Affairs, and the Journal of the American Medical Association. You can follow her on Twitter @kleachkemon.