@article {micah_health_2020, title = {Health sector spending and spending on HIV/AIDS, tuberculosis, and malaria, and development assistance for health: progress towards Sustainable Development Goal 3}, journal = {The Lancet}, year = {2020}, note = {Publisher: Elsevier}, month = {apr}, abstract = {\textlessh2\textgreaterSummary\textless/h2\textgreater\textlessh3\textgreaterBackground\textless/h3\textgreater\textlessp\textgreaterSustainable 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.\textless/p\textgreater\textlessh3\textgreaterMethods\textless/h3\textgreater\textlessp\textgreaterWe 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.\textless/p\textgreater\textlessh3\textgreaterFindings\textless/h3\textgreater\textlessp\textgreaterSince the development and implementation of the SDGs in 2015, global health spending has increased, reaching \$7{\textperiodcentered}9 trillion (95\% uncertainty interval 7{\textperiodcentered}8{\textendash}8{\textperiodcentered}0) in 2017 and is expected to increase to \$11{\textperiodcentered}0 trillion (10{\textperiodcentered}7{\textendash}11{\textperiodcentered}2) by 2030. In 2017, in low-income and middle-income countries spending on HIV/AIDS was \$20{\textperiodcentered}2 billion (17{\textperiodcentered}0{\textendash}25{\textperiodcentered}0) and on tuberculosis it was \$10{\textperiodcentered}9 billion (10{\textperiodcentered}3{\textendash}11{\textperiodcentered}8), and in malaria-endemic countries spending on malaria was \$5{\textperiodcentered}1 billion (4{\textperiodcentered}9{\textendash}5{\textperiodcentered}4). Development assistance for health was \$40{\textperiodcentered}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{\textperiodcentered}6\% (81{\textperiodcentered}6{\textendash}81{\textperiodcentered}7) in 2015 to 83{\textperiodcentered}1\% (82{\textperiodcentered}8{\textendash}83{\textperiodcentered}3) in 2030.\textless/p\textgreater\textlessh3\textgreaterInterpretation\textless/h3\textgreater\textlessp\textgreaterHealth 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.\textless/p\textgreater\textlessh3\textgreaterFunding\textless/h3\textgreater\textlessp\textgreaterThe Bill \& Melinda Gates Foundation.\textless/p\textgreater}, issn = {0140-6736, 1474-547X}, doi = {10.1016/S0140-6736(20)30608-5}, url = {https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30608-5/abstract}, author = {Micah, Angela E. and Su, Yanfang and Bachmeier, Steven D. and Chapin, Abigail and Cogswell, Ian E. and Crosby, Sawyer W. and Cunningham, Brandon and Harle, Anton C. and Maddison, Emilie R. and Moitra, Modhurima and Sahu, Maitreyi and Schneider, Matthew T. and Simpson, Kyle E. and Stutzman, Hayley N. and Tsakalos, Golsum and Zende, Rahul R. and Zlavog, Bianca S. and Abbafati, Cristiana and Abebo, Zeleke Hailemariam and Abolhassani, Hassan and Abrigo, Michael R. M. and Ahmed, Muktar Beshir and Rufus Olusola Akinyemi and Alam, Khurshid and Ali, Saqib and Alinia, Cyrus and Alipour, Vahid and Syed Mohamed Aljunid and Almasi, Ali and Alvis-Guzman, Nelson and Ancuceanu, Robert and Andrei, Tudorel and Andrei, Catalina Liliana and Mina Anjomshoa and Antonio, Carl Abelardo T. and Arabloo, Jalal and Arab-Zozani, Morteza and Olatunde Aremu and Atnafu, Desta Debalkie and Marcel Ausloos and Avila-Burgos, Leticia and Ayanore, Martin Amogre and Azari, Samad and Babalola, Tesleem Kayode and Bagherzadeh, Mojtaba and Baig, Atif Amin and Bakhtiari, Ahad and Maciej Banach and Banerjee, Srikanta K. and Till Winfried B{\"a}rnighausen and Basu, Sanjay and Baune, Bernhard T. and Bayati, Mohsen and Berman, Adam E. and Bhageerathy, Reshmi and Bhardwaj, Pankaj and Bohluli, Mehdi and Reinhard Busse and Cahuana-Hurtado, Lucero and C{\'a}mera, Luis LA Alberto and Casta{\~n}eda-Orjuela, Carlos A. and Catal{\'a}-L{\'o}pez, Ferr{\'a}n and Cevik, Muge and Chattu, Vijay Kumar and Lalit Dandona and Dandona, Rakhi and Dianatinasab, Mostafa and Do, Hoa Thi and Doshmangir, Leila and Tantawi, Maha El and Eskandarieh, Sharareh and Esmaeilzadeh, Firooz and Faraj, Anwar and Farzadfar, Farshad and Fischer, Florian and Foigt, Nataliya A. and Fullman, Nancy and Gad, Mohamed M. and Ghafourifard, Mansour and Ghashghaee, Ahmad and Gholamian, Asadollah and Goharinezhad, Salime and Ayman Grada and Bidgoli, Hassan Haghparast and Hamidi, Samer and Harb, Hilda L. and Hasanpoor, Edris and Hay, Simon I. and Delia Hendrie and Henry, Nathaniel J. and Herteliu, Claudiu and Hole, Michael K. and Mehdi Hosseinzadeh and Hostiuc, Sorin and Huda, Tanvir M. and Humayun, Ayesha and Hwang, Bing-Fang and Olayinka Stephen Ilesanmi and Usman Iqbal and Irvani, Seyed Sina N. and Islam, Sheikh Mohammed Shariful and Islam, M. Mofizul and Jahani, Mohammad Ali and Mihajlo Jakovljevic and James, Spencer L. and Javaheri, Zohre and Jonas, Jost B. and Joukar, Farahnaz and Jacek Jerzy Jozwiak and J{\"u}risson, Mikk and Kalhor, Rohollah and Behzad Karami Matin and Karimi, Salah Eddin and Kayode, Gbenga A. and Ali Kazemi Karyani and Kinfu, Yohannes and Adnan Kisa and Stefan Kohler and Komaki, Hamidreza and Kosen, Soewarta and Kotlo, Anirudh and Koyanagi, Ai and Kumar, G. Anil and Kusuma, Dian and Lansingh, Van C. and Larsson, Anders O. and Lasrado, Savita and Lee, Shaun Wen Huey and Lee-Ling Lim and Rafael Lozano and Hassan Magdy Abd El Razek and Mahdavi, Mokhtar Mahdavi and Maleki, Shokofeh and Malekzadeh, Reza and Mansour-Ghanaei, Fariborz and Mohammad Ali Mansournia and Mantovani, Lorenzo Giovanni and Gabriel Martinez and Masoumi, Seyedeh Zahra and Benjamin Ballard Massenburg and Menezes, Ritesh G. and Mengesha, Endalkachew Worku and Meretoja, Tuomo J. and Meretoja, Atte and Tomislav Mestrovic and Kostova, Neda Milevska and Miller, Ted R. and Andreea Mirica and Mirrakhimov, Erkin M. and Moghadaszadeh, Masoud and Mohajer, Bahram and Mohamadi, Efat and Darwesh, Aso Mohammad and Mohammadian-Hafshejani, Abdollah and Mohammadpourhodki, Reza and Mohammed, Shafiu and Mohebi, Farnam and Mokdad, Ali H. and Shane Douglas Morrison and Mosser, Jonathan F. and Seyyed Meysam Mousavi and Muriithi, Moses K. and Saravanan Muthupandian and Myint, Chaw-Yin and Naderi, Mehdi and Nagarajan, Ahamarshan Jayaraman and Nguyen, Cuong Tat and Nguyen, Huong Lan Thi and Nonvignon, Justice and Jean Jacques Noubiap and Oh, In-Hwan and Olagunju, Andrew T. and Olusanya, Jacob Olusegun and Olusanya, Bolajoko Olubukunola and Bali, Ahmed Omar and Onwujekwe, Obinna E. and Otstavnov, Stanislav S. and Otstavnov, Nikita and Mayowa Ojo Owolabi and Padubidri, Jagadish Rao and Palladino, Raffaele and Panda-Jonas, Songhomitra and Pandey, Anamika and Postma, Maarten J. and Prada, Sergio I. and Pribadi, Dimas Ria Angga and Rabiee, Mohammad and Rabiee, Navid and Fakher Rahim and Ranabhat, Chhabi Lal and Rao, Sowmya J. and Rathi, Priya and Rawaf, Salman and David Laith Rawaf and Rawal, Lal and Rawassizadeh, Reza and Rezapour, Aziz and Sabour, Siamak and Sahraian, Mohammad Ali and Salman, Omar Mukhtar and Joshua A. Salomon and Samy, Abdallah M. and Juan Sanabria and Jo{\~a}o Vasco Santos and Milicevic, Milena M. Santric and Bruno Piassi Sao Jose and Savic, Miloje and Schwendicke, Falk and Senthilkumaran, Subramanian and Sepanlou, Sadaf G. and Edson Serv{\'a}n-Mori and Setayesh, Hamidreza and Shaikh, Masood Ali and Sheikh, Aziz and Kenji Shibuya and Shrime, Mark G. and Simonetti, Biagio and Singh, Jasvinder A. and Singh, Pushpendra and Skryabin, Valentin Yurievich and Soheili, Amin and Soltani, Shahin and Stefan, Simona C{\u a}t{\u a}lina and Tabar{\'e}s-Seisdedos, Rafael and Topor-Madry, Roman and Marcos Roberto Tovani-Palone and Tran, Bach Xuan and Travillian, Ravensara and Undurraga, Eduardo A. and Valdez, Pascual R. and Boven, Job F. M. van and Tommi Juhani Vasankari and Violante, Francesco S. and Vasily Vlassov and Vos, Theo and Wolfe, Charles D. A. and Wu, Junjie and Yaya, Sanni and Yazdi-Feyzabadi, Vahid and Yip, Paul and Yonemoto, Naohiro and Younis, Mustafa Z. and Chuanhua Yu and Zaidi, Zoubida and Sojib Bin Zaman and Zastrozhin, Mikhail Sergeevich and Zhang, Zhi-Jiang and Zhao, Yingxi and Christopher J.L. Murray and Dieleman, Joseph L.} }