Although knowledge about global health financing has expanded over the past two decades, major gaps remain. We know little, for example, about how much governments spend on major disease areas, how these amounts have evolved over time and how countries compare. A global health financing data revolution is sorely needed. The suite of papers that make up this special issue underline the importance of reliable information about financial resources for health.
Annie Haakenstad, MA, ScD, is an Assistant Professor in Health Metrics Sciences at the Institute for Health Metrics and Evaluation (IHME) at the University of Washington. Dr. Haakenstad is a faculty member on the Health Systems team. Her research focuses on financial risk protection, disparities in access to health services, and health financing.
Dr. Haakenstad obtained her doctoral degree from Harvard University, her Masters in Development Studies from the Graduate Institute of International and Development Studies in Geneva, Switzerland, and her Bachelors in International Relations from the George Washington University. Prior to joining IHME as an Assistant Professor, she was a Postdoctoral Research Associate in the Department of Global Health and Population at Harvard. She also worked previously as a Project Officer for IHME and has consulted for the World Bank, United Nations Offices at Geneva, United Nations Environment Program, and UNICEF.
IHME was established at the University of Washington in Seattle in 2007. Its mission is to deliver to the world timely, relevant, and scientifically valid evidence to improve health policy and practice.
GBD 2019 Healthcare Access and Quality Collaborators. Assessing performance of the Healthcare Access and Quality Index, overall and by select age groups, for 204 countries and territories, 1990–2019: a systematic analysis from the Global Burden of Disease Study 2019. The Lancet Global Health. 6 October 2022. doi: 10.1016/S2214-109X(22)00429-6.
Johnson EK, Wojtesta MA, Crosby SW, et al. Varied health spending growth across US states was associated with income, price levels, and Medicaid expansion, 2000-19. Health Affairs. 1 August 2022. doi: 10.1377/hlthaff.2021.01834.
Haakenstad A, Angelino O, Irvine CMS, et al. Measuring contraceptive method mix, prevalence, and demand satisfied by age and marital status in 204 countries and territories, 1970–2019: a systematic analysis for the Global Burden of Disease Study 2019. The Lancet. 21 July 2022. doi: 10.1016/S0140-6736(22)00936-9.
GBD 2019 Human Resources for Health Collaborators. Measuring the availability of human resources for health and its relationship to universal health coverage: estimates for 204 countries and territories from 1990 to 2019. The Lancet. 23 May 2022. doi: 10.1016/S0140-6736(22)00532-3.
The Gender Equality Metrics team and the COVID-19 Forecasting team at Institute for Health Metrics and Evaluation. Quantifying the effects of the COVID-19 pandemic on gender equality in health, social, and economic indicators. The Lancet. 2 March 2022. doi: 10.1016/S0140-6736(22)00008-3.
Global Burden of Disease 2020 Health Financing Collaborator Network. Tracking development assistance for health and for COVID-19: a review of development assistance, government, out-of-pocket, and other private spending on health for 204 countries and territories, 1990–2050. The Lancet. 22 September 2021. doi: 10.1016/S0140-6736(21)01258-7.
Dieleman JL, Murray CJL, Chen C, Crosby SW, Liu A, McCracken D, Pollock IA, Sahu M, Tsakalos G, Dwyer-Lindgren L, Haakenstad A, Mokdad AH, Roth GA, Scott KW. US Health Care Spending by Race and Ethnicity, 2002-2016. JAMA. 17 August 2021. doi: 10.1001/jama.2021.9937.
Feachem RGA, Chen I, Akbari O, Bertozzi-Villa A, Bhatt S, Binka F, Boni MF, Buckee C, Dieleman J, Dondorp A, Eapen A, Feachem NS, Filler S, Gething P, Gosling R, Haakenstad A, Harvard K, Hatefi A, Jamison D, Jones KE, Karema C, Kamwi RN, Lal A, Larson E, Lees M, Lobo NF, Micah AE, Moonen B, Newby G, Ning X, Pate M, Quiñones M, Roh M, Rolfe B, Shanks D, Singh B, Staley K, Tulloch J, Wegbreit J, Woo HJ, Mpanju-Shumbusho W. Malaria eradication within a generation: ambitious, achievable, and necessary. The Lancet. 8 September 2019. doi:10.1016/S0140-6736(19)31139-0.
Haakenstad A, Moses MW, Tao T, Tsakalos G, Zlavog B, Kates J, Wexler A, Murray CJL, Dieleman JL. Potential for additional government spending on HIV/AIDS in 137 low-income and middle-income countries: an economic modelling study. The Lancet HIV. 24 April 2019. doi: http://dx.doi.org/10.1016/S1473-3099(19)30165-3
Haakenstad A, Harle AC, Tsakalos G, Micah AE, Tao T, Anjomshoa M, Cohen J, Fullman N, Hay S, Mestrovic T, Mohammed S, Mousavi SM, Nixon MR, Pigott D, Tran K, Murray CJL, Dieleman JL. Tracking spending on malaria by source in 106 countries, 2000–16: an economic modelling study. The Lancet Infectious Disease. 24 April 2019. doi: http://dx.doi.org/10.1016/S1473-3099(19)30165-3
Global Burden of Disease Health Financing Collaborator Network. Past, present, and future of global health financing: a review of development assistance, government, out-of-pocket, and other private spending on health for 195 countries, 1995–2050. The Lancet. 24 April 2019. doi: http://dx.doi.org/10.1016/S0140-6736(19)30841-4
Global Burden of Disease Health Financing Collaborator Network. Spending on health and HIV/AIDS: domestic health spending and development assistance in 188 countries, 1995–2015. The Lancet. 17 Apr 2018.
Mokdad AH, Palmisano EB, Zúñiga-Brenes P, et al. Supply-side interventions to improve health: Findings from the Salud Mesoamérica Initiative. PLoS ONE. 16 Apr 2018; 13(4):e0195292. https://doi.org/10.1371/journal.pone.0195292
Wollum A, Dansereau E, Fullman N, Achan J, Bannon KA, Burstein R, Conner RO, DeCenso B, Gasasira A, Haakenstad A, Hanlon M, Ikilezi G, Kisia C, Levine AJ, Masters SH, Njuguna P, Okiro EA, Odeny TA, Roberts DA, Gakidou E, Duber HC. The effect of facility-based antiretroviral therapy programs on outpatient services in Kenya and Uganda. BMC Health Services Research. 2017 Aug 16. doi: 10.1186/s12913-017-2512-9.
Shretta R, Zelman B, Birger ML, Haakenstad A, Singh L, Liu Y, Dieleman J. Tracking development assistance and government health expenditures for 35 malaria-eliminating countries: 1990–2017. Malaria Journal. 14 Jun 2017: 16:251. DOI: 10.1186/s12936-017-1890-0
Global Burden of Disease Health Financing Collaborator Network. Future and potential spending on health 2015–2040: development assistance for health, and government, prepaid private, and out-of-pocket health spending in 184 countries. The Lancet. 19 April 2017. http://dx.doi.org/10.1016/S0140-6736(17)30873-5
Global Burden of Disease Health Financing Collaborator Network. Evolution and patterns of global health financing 1995–2014: development assistance for health, and government, prepaid private, and out-of-pocket health spending in 184 countries. The Lancet. 19 April 2017. http://dx.doi.org/10.1016/S0140-6736(17)30874-7
Hernandez B, Colombara DV, Gagnier MC, Desai SS, Haakenstad A, Johanns C, CR McNellan, Nelson J, Palmisano EB, Ríos-Zertuche D, Schaefer A, Zúñiga-Brenes P, Iriarte E, Mokdad AH. Barriers and facilitators for institutional delivery among poor Mesoamerican women: a cross-sectional study. Health Policy and Planning. 15 Mar 2017. doi: https://doi.org/10.1093/heapol/czx010
Lim SS, Allen K, Bhutta ZA, et al. Measuring the health-related Sustainable Development Goals in 188 countries: a baseline analysis from the Global Burden of Disease Study 2015. The Lancet. 2016 Sep 21. doi: 10.1016/S0140-6736(16)31467-2.
Dansereau E, McNellan CR, Gagnier MC, Desai SS, Haakenstad A, Johanns CK, Palmisano EB, Ríos-Zertuche D, Schaefer A, Zúñiga-Brenes P, Hernandez B, Iriarte E, Mokdad AH. Coverage and timing of antenatal care among poor women in 6 Mesoamerican countries. BMC Pregnancy and Childbirth. 2016 Aug 19; 16:234. DOI: 10.1186/s12884-016-1018-5
Di Giorgio L, Moses MW, Fullman N, et al. The potential to expand antiretroviral therapy by improving health facility efficiency: evidence from Kenya, Uganda, and Zambia. BMC Medicine. 2016 20 July. doi: 10.1186/s12916-016-0653-z.
Dieleman JL, Schneider MT, Haakenstad A, Singh L, Sadat N, Birger M, Reynolds A, Templin T, Hamavid H, Chapin A, Murray CJL. Development assistance for health: past trends, associations, and the future of international financial flows for health. The Lancet. 2016 Apr 13. doi: 10.1016/S0140-6736(16)30168-4.
Duber HC, Roberts DA, Ikilezi G, Fullman N, Gasasira A, Gakidou G, Haakenstad A, Levine AJ, Achan J. Evaluating facility-based antiretroviral therapy program effectiveness: a pilot study comparing viral load suppression and retention rates. Tropical Medicine & Hygiene. 2016 March 21. doi: 10.1111/tmi.12694.
Haakenstad A, Birger M, Singh L, Liu P, Lim S, Ng M, Dieleman JL. Vaccine assistance to low- and middle-income countries increased to $3.6 billion in 2014. Health Affairs. 2016 Feb 8.
Mokdad AH, Gagnier MC, Colson KE, Dansereau E, Zúñiga-Brenes P, Ríos-Zertuche D, et al. Missed Opportunities for Measles, Mumps, and Rubella (MMR) Immunization in Mesoamerica: Potential Impact on Coverage and Days at Risk. PLoS ONE . 2015; 10(10): e0139680. doi:10.1371/journal.pone. 0139680.
Dieleman JL, Graves C, Johnson E, Templin T, Birger M, Hamavid H, Freeman M, Leach-Kemon K, Singh L, Haakenstad A, Murray CJL. Sources and focus of health development assistance, 1990–2014. JAMA. 2015 Jun 16. 313(23):2359-2368. doi:10.1001/jama.2015.5825.
Haakenstad A, Johnson E, Graves C, Olivier J, Duff J, Dieleman JL. Estimating the development assistance for health provided to faith-based organizations, 1990–2013. PLOS One. 2015 June 4. doi: 10.1371/journal.pone.0128389.
Bui AL, Lavado RF, Johnson EK, Brooks BPC, Freeman MK, Graves CM, Haakenstad A, Shoemaker B, Hanlon M, Dieleman JL. National health accounts data from 1996 to 2010: a systematic review. Bulletin of the World Health Organization. 2015 May 15. Article ID: BLT.14.145235.
Dieleman JL, Yamey G, Johnson EK, Graves CM, Haakenstad A, Meara JG. Tracking global expenditures on surgery: gaps in knowledge hinder progress. The Lancet Global Health. 2015 April 27. doi: 10.1016/S2214-109X(15)70075-6.
Graves CM, Haakenstad A, Dieleman JL. Tracking development assistance for health to fragile states: 2005–2011. Globalization and Health. 2015 March 19; 11:12. doi:10.1186/s12992-015-0097-9.
Masters SH, Burstein R, DeCenso B, Moore K, Haakenstad A, Ikilezi G, Achan J, Osei I, Gashong B, Kisia C, Njuguna P, Babigumira J, Kumar S, Hanlon M, Gakidou E. Pharmaceutical availability across levels of care: evidence from facility surveys in Ghana, Kenya, and Uganda. PLOS ONE. 2014; 9(12): e114762.
Leach-Kemon K, Graves CM, Johnson EK, Lavado RF, Hanlon M, Haakenstad A. Vaccine resource tracking systems. BMC Health Services Research. 2014 Sept 22; 14:421. doi:10.1186/1472-6963-14-421.
Dieleman JL, Graves CM, Templin T, Johnson E, Baral R, Leach-Kemon K, Haakenstad AM, Murray CJL. Global health development assistance remained steady in 2013 but did not align with recipients’ disease burden. Health Affairs. 2014 Apr. doi: 10.1377/hlthaff.2013.1432.
Hanlon M, Graves CM, Brooks BPC, Haakenstad A, Lavado R, Leach-Kemon K, Dieleman JL. Regional variation in the allocation of development assistance for health. Globalization and Health. 2014; 10:8.
March 23, 2017
November 8, 2016
After more than a decade of immense growth, development assistance for health has flatlined. DAH fueled a scale up of antiretrovirals, insecticide-treated bed nets, vaccinations and a host of important global health interventions. Over the same period, the spread of a number of infectious diseases was reversed, reducing premature death and disability across the developing world. The plateau in international funding may threaten to slow progress or even roll back these gains.
January 2, 2015
In The Lancet Global Health, Stephen Resch and colleagues’ study benchmarks 12 countries’ government expenditure on HIV/AIDS. This important research emphasizes that many governments are not meeting spending goals, and in many countries the financing gaps are so great that, even if they met the spending goals, expenditure would still fall short of what is needed (expenditure would cover only 64% of estimated future funding requirements, leaving a gap of around a third of the total US$7.9 billion needed).