Health sector spending and spending on HIV/AIDS, tuberculosis, and malaria, and development assistance for health: progress towards Sustainable Development Goal 3
Health sector spending and spending on HIV/AIDS, tuberculosis, and malaria, and development assistance for health: progress towards Sustainable Development Goal 3
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DOI：
10.1016/s0140-6736(20)30608-5
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发表时间：
2020-09-05
期刊：
影响因子：
168.9
通讯作者：
Dieleman, Joseph L.
中科院分区：
文献类型：
--
作者：
Micah, Angela E.;Su, Yanfang;Dieleman, Joseph L.
背景可持续发展目标（SDG）3旨在“确保健康生活，促进所有年龄段所有人的福祉”。虽然在量化实现可持续发展目标3的进展方面做出了大量努力，但关注跟踪实现这一目标的支出的研究较少。我们使用支出估算来衡量为可持续发展目标3的优先领域提供资金的进展情况，检查成果与资金之间的关联，并确定在哪些方面最需要资源收益来实现可持续发展目标3的可用数据指标。方法（政府，自付和预付私人）从1995年到2017年为195个国家和地区。对于特定疾病的卫生支出，我们估计了2000年至2017年135个低收入和中等收入国家的艾滋病毒/艾滋病和结核病支出，以及106个疟疾流行国家的疟疾支出。我们还按来源、支付发展机构、受援国和卫生重点领域（包括用于大流行防范的卫生发展援助）估计了1990年至2019年的卫生发展援助（DAH）。最后，我们估计了195个国家和地区从2018年到2030年的未来卫生支出。结果自2015年制定和实施可持续发展目标以来，全球卫生支出一直在增加，2017年达到7.9万亿美元（95%不确定性区间7.8-8.0），预计到2030年将增加到11.0万亿美元（10.7-11.2）。2017年，低收入和中等收入国家用于艾滋病毒/艾滋病的支出为202亿美元（17.0-25.0），结核病为109亿美元（10.3-11.8），疟疾流行国家用于疟疾的支出为51亿美元（4.9-5.4）。2019年卫生发展援助为406亿美元，艾滋病毒/艾滋病是自2004年以来获得最高捐款的卫生重点领域。2019年，DAH中有3.74亿美元用于大流行准备，不到DAH的1%。尽管自2015年以来，艾滋病毒/艾滋病、结核病和疟疾方面的支出有所增加，但并非所有国家的支出都有所增加，流行率、发病率和人均支出方面的结果喜忧参半。来自集合来源的卫生支出比例预计将从2015年的81.6%（81.6-81.7）增加到2030年的83.1%（82.8-83.3）。解释可持续发展目标3优先领域的卫生支出有所增加，但并非所有国家都是如此，实现可持续发展目标3目标的进展参差不齐，因国家和目标而异。关于扩大开支和改善保健成果的证据表明，两者之间存在着微妙的关系，例如，开支的增加并不总是导致成果的改善。尽管各国可能需要更多资源来实现可持续发展目标3，但也需要解决更广泛的卫生系统中的其他制约因素，如干预措施和人口之间的资源分配效率低下、治理体系薄弱、人力资源短缺和药物短缺。版权所有（C）2020作者。爱思唯尔有限公司出版
Background Sustainable 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.Methods We 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.Findings Since the development and implementation of the SDGs in 2015, global health spending has increased, reaching $7.9 trillion (95% uncertainty interval 7.8-8.0) in 2017 and is expected to increase to $11.0 trillion (10.7-11.2) by 2030. In 2017, in low-income and middle-income countries spending on HIV/AIDS was $20.2 billion (17.0-25.0) and on tuberculosis it was $10.9 billion (10.3-11.8), and in malaria-endemic countries spending on malaria was $5.1 billion (4.9-5.4). Development assistance for health was $40.6 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 81.6% (81.6-81.7) in 2015 to 83.1% (82.8-83.3) in 2030.Interpretation Health 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. Copyright (C) 2020 The Author(s). Published by Elsevier Ltd.