Anne Gulland, Global health security correspondent
Countries around the world are spending a greater proportion of their domestic budgets on health but the poorest states still lag far behind richer ones, according to a new report.
The analysis of spending on health by all 194 member states of the World Health Organization has found that in 2016 the world spent $7.5 trillion (£5.75 trillion) on health, close to 10 per cent of global gross domestic product (GDP).
The growth was mainly driven by an increase in per capita GDP and an increase in overall public spending.
On average $1,000 was spent on health per person in 2016 but half of the world’s countries spent less than $350 per person.
According to the analysis, only 20 per cent of the world’s population live in high-income countries but these countries account for almost 80 per cent of spending on health.
The top 10 countries spent $5,000 or more per person in 2016, compared to less than $30 per person in the bottom 10 countries. This gap between the highest and lowest spenders has shown little sign of shifting since 2000, the report said.
In high-income countries, public spending on health per person went from an average of $1,357 in 2000 to $2,257 in 2016, a 66 per cent increase.
Over the period studied, as countries became richer their domestic spending on health increased and their reliance on aid decreased. Upper middle-income countries saw the greatest increase in domestic spending: from $130 per person per year in 2000 to $270 in 2016. This was accompanied by a drop in external aid.
Lower-middle-income countries saw an increase in both internal and external funding on health. Domestic funding increased from an average of $30 to $58 per person between 2000 and 2016, while external funding went from $2.6 to $6.8 over the same period.
However, in low-income countries, donor funding per capita almost tripled from $4 to $10 but domestic funding only increased slightly from $7 to $9 per person.
The analysis found that nearly half of donor funds on health went on HIV/Aids (28 per cent of all donor funds), malaria (14 per cent) and tuberculosis (four per cent).
The report found that the external funding for HIV/Aids does not show a clear relationship with national prevalence or income level, varying by as much as $700 per person in different countries. The report said this discrepancy warranted further research.
The good news is that spending by individuals on health care has decreased – meaning that fewer people face financial hardship if they fall ill.
The greatest decrease in what is known as out-of-pocket spending occurred in south-east Asia where such spending fell from an average of 56 per cent of total health expenditure in 2000 to 44 per cent in 2016. In Africa, the share also declined from 46 per cent to 37 per cent of health spending.
Agnès Soucat, director of health systems governance and financing at the WHO, said the report was good news in many ways.
“We are seeing a transformation in the way that health is funded in the sense that there is more public spending, less out-of-pocket spending and we have also seen a declining role of aid,” she said.
She said that aid funding made up less than one per cent of the total spent on health around the world.
“Most of this good news is related to economic growth. When countries get richer they spend more on health and when people are richer and more educated they ask their governments for more money,” she said.
But Dr Soucat added that low-income countries needed to be encouraged to use more domestic funding on health.
“You could do a grand bargain with a country where the donor says it is going to fund some investment in infrastructure but the country should cover the cost of wages, medicines and vaccines,” she said.