London School of Hygiene & Tropical Medicine

Millions of people could be without access to even the most basic health services as low domestic investment and stagnating international aid leaves developing countries facing a health financing crisis, according to two studies published in the journal The Lancet.

Dr Joseph Dieleman, from the Institute for Health Metrics and Evaluation, Seattle, USA, who led the study believes the findings are a wake-up call to global leaders and governments to deliver greater investment in health.

The research estimates that by 2040, average health spending per person will range from US$164 in low-income countries to US$9019 in high-income countries, remaining lowest in sub-Saharan Africa in countries like Somalia (US$34), and highest in the USA (US$16592). Many low-income countries are not expected to reach even the most basic globally agreed financing targets by 2040.

So how can the crisis be alleviated and what needs to be done to achieve universal health coverage? Kara Hanson, Professor of Health System Economics at the London School of Hygiene & Tropical Medicine, said:

"The world has achieved tremendous gains in health over past decades. However, as this important and timely study reminds us, these achievements are under threat from the current downturn in global economic growth which is also jeopardising the prospects for universal health coverage in low and middle-income countries.

"Achieving universal health coverage requires shifting health financing systems from a reliance on out-of-pocket payments made at the time of illness, which can drive households into poverty, to one where payments are pooled, either through tax revenue or social health insurance.

"Reforms to revenue collection agencies, sin taxes and other earmarked revenue sources are all important measures. Redirecting a share of out-of-pocket payments, which make up 50% of total health expenditure in low- and lower-middle income countries, to pooled sources such as social health insurance is vital.

"Using existing funds more efficiently is also important. Finance ministries need to be confident that they are getting value for money if they are to consider increases in health funding.

"Donor agencies must continue to play a role in financing health in the poorest countries where local resources cannot meet the requirements of even a basic package of health services. The UK has been a key funder of health systems in the past, and during these turbulent economic times we must maintain this commitment to the worlds' poorest."

Publications

• Joseph L Dieleman, Tara Templin, Nafis Sadat, Patrick Reidy, Abigail Chapin, Kyle Foreman, Annie Haakenstad, Tim Evans, Prof Christopher J L Murray, Christoph Kurowski. National spending on health by source for 184 countries between 2013 and 2040. The Lancet. DOI: 10.1016/S0140-6736(16)30167-2
• Dr Joseph L Dieleman, Matthew T Schneider, Annie Haakenstad, Lavanya Singh, Nafis Sadat, Maxwell Birger, Alex Reynolds, Tara Templin, Hannah Hamavid, Abigail Chapin, Christopher J L Murray. Development assistance for health: past trends, associations, and the future of international financial flows for health. The Lancet. DOI:10.1016/S0140-6736(16)30168-4