Angela E. MicahIan E. CogswellBrandon CunninghamSatoshi EzoeAnton C. HarleEmilie R. MaddisonDarrah McCrackenShuhei NomuraKyle E. SimpsonHayley N. StutzmanGolsum TsakalosLindsey E. WallaceYingxi ZhaoRahul R. ZendeCristiana AbbafatiMichael AbdelmassehAidin AbediKedir Hussein AbegazE. S. AbhilashHassan AbolhassaniMichael R.M. AbrigoTara Ballav AdhikariSaira AfzalBright Opoku AhinkorahSepideh AhmadiHaroon AhmedMuktar Beshir AhmedTarik Ahmed RashidMarjan AjamiBudi AjiYonas AkaluChisom Joyqueenet AkunnaHanadi Al HamadKhurshid AlamFahad Mashhour AlaneziTurki M. AlanziYosef AlemayehuRobert Kaba AlhassanCyrus AliniaSyed Mohamed AljunidSami Almustanyir AlmustanyirNelson Alvis-GuzmanNelson J. Alvis-ZakzukSaeed AminiMostafa Amini-RaraniHubert AmuRobert AncuceanuCatalina Liliana AndreiTudorel AndreiBlake AngellMina AnjomshoaCarl Abelardo T. AntonioCatherine M. AntonyMuhammad AqeelJalal ArablooMorteza Arab-ZozaniTimur AripovAlessandro ArrigoTahira AshrafDesta Debalkie AtnafuMarcel AusloosLeticia Avila-BurgosAsma Tahir AwanGetinet AyanoMartin Amogre AyanoreSamad AzariGulrez Shah AzharTesleem Kayode BabalolaMohammad Amin BahramiAtif Amin BaigMaciej BanachNastaran BaratiTill Winfried BärnighausenAmadou BarrowSanjay BasuBernhard T. BauneMohsen BayatiHabib BenzianAdam E. BermanAkshaya Srikanth BhagavathulaNikha BhardwajPankaj BhardwajSonu BhaskarSadia BibiAli BijaniVirginia BodolicaNicola Luigi BragazziDejana BraithwaiteNicholas J.K. BreitbordeAlexey V. BreusovNikolay Ivanovich BrikoReinhard BusseLucero Cahuana-HurtadoEmily Joy CallanderLuis Alberto CámeraCarlos A. Castañeda-OrjuelaFerrán Catalá-LópezJaykaran CharanSouranshu ChatterjeeSoosanna Kumary ChattuUniversity of Kurdistan HewlêrCollege of Medicine Alfaisal UniversitySchool of Business AdministrationUniversity of Leicester School of BusinessMurdoch Business SchoolHealth Human Resources Research Center (SUMS)Research Center for ImmunodeficienciesUniversity of Florida HealthSocial Determinants of Health Research Center, Birjand University of Medical SciencesUniversity of The GambiaMelbourne Medical SchoolUniversity of Health and Allied Sciences, GhanaMadda Walabu UniversityArba Minch UniversityAll India Institute of Medical Sciences, JodhpurBucharest University of Economic StudiesUniversidad de la CostaGeorge Institute for Global HealthImam Abdulrahman Bin Faisal universityCapella UniversityUniversiti Sultan Zainal AbidinFoundation University, IslamabadInstitute for Health Metrics and EvaluationThe Faculty of Health SciencesCOMSATS University IslamabadUniversity of GondarSree Narayana Guru College, ChelannurUniversity of Agriculture, FaisalabadRumailah HospitalHamad Medical CorporationInstytut Centrum Zdrowia Matki PolkiUniversity of the Philippines ManilaUniversidad Peruana Cayetano HerediaJimma UniversityBahar Dar UniversityUniversity of LahoreHealth Sciences Center KuwaitUniversitas Jenderal SoedirmanUniversidad Nacional de ColombiaUniversidad de CartagenaUniversitatea de Medicina si Farmacie Carol Davila din BucurestiMinistry of Health Saudi ArabiaHarvard T.H. Chan School of Public HealthSapienza Università di RomaUniversity of Nevada, Las VegasUniversity of South AustraliaArak University of Medical SciencesChildren's Hospital BostonAarhus UniversitetUniversity of Southern CaliforniaTehran University of Medical SciencesBabol University of Medical SciencesKeio UniversityThe University of TokyoUniversità degli Studi di GenovaMedical College of GeorgiaUniversity of Technology SydneyIRCCS Ospedale San RaffaeleBirjand University of Medical SciencesInstituto Nacional de Salud Pública. MéxicoUniversity College LondonShiraz University of Medical SciencesNew York UniversityUrmia University of Medical SciencesIsfahan University of Medical SciencesKarolinska UniversitetssjukhusetShahid Beheshti University of Medical SciencesUniversität HeidelbergCharles UniversityNational Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical SciencesImperial College LondonRUDN UniversityUniversity of FloridaFaculty of Medicine, Nursing and Health SciencesTechnische Universität BerlinUniversity of KwaZulu-NatalSechenov First Moscow State Medical UniversityHarvard UniversityNuffield Department of MedicineHong Kong Polytechnic UniversityUnited Arab Emirates UniversityInstituto Universitario del Hospital Italiano de Buenos AiresHamadan University of Medical SciencesMedical University of LodzYakin Doğu ÜniversitesiUniversity of LagosMarshall UniversityRAND CorporationThe Ohio State UniversityOttawa Hospital Research InstituteUniversiti Kebangsaan MalaysiaInstituto de Salud Carlos IIIWestfälische Wilhelms-Universität MünsterSouth West Sydney Local Heath District and Liverpool HospitalNSW Brain Clot BankMedanta MedicityFederal Ministry of HealthGovernment Medical College PaliNepal Health FrontiersTexila American UniversityTashkent Institute of Postgraduate Medical EducationPhilippine Institute for Development StudiesKing Edward UniversityNational Institute of HealthArgentine Society of MedicineThe Intercountry Centre for Oral Health (ICOH) for AfricaInstitute of Public HealthMinistry of Health2022-08-042022-08-042021-10-09The Lancet. Vol.398, No.10308 (2021), 1317-13431474547X014067362-s2.0-85116527441https://repository.li.mahidol.ac.th/handle/123456789/77765Background: The rapid spread of COVID-19 renewed the focus on how health systems across the globe are financed, especially during public health emergencies. Development assistance is an important source of health financing in many low-income countries, yet little is known about how much of this funding was disbursed for COVID-19. We aimed to put development assistance for health for COVID-19 in the context of broader trends in global health financing, and to estimate total health spending from 1995 to 2050 and development assistance for COVID-19 in 2020. Methods: We estimated domestic health spending and development assistance for health to generate total health-sector spending estimates for 204 countries and territories. We leveraged data from the WHO Global Health Expenditure Database to produce estimates of domestic health spending. To generate estimates for development assistance for health, we relied on project-level disbursement data from the major international development agencies' online databases and annual financial statements and reports for information on income sources. To adjust our estimates for 2020 to include disbursements related to COVID-19, we extracted project data on commitments and disbursements from a broader set of databases (because not all of the data sources used to estimate the historical series extend to 2020), including the UN Office of Humanitarian Assistance Financial Tracking Service and the International Aid Transparency Initiative. We reported all the historic and future spending estimates in inflation-adjusted 2020 US$, 2020 US$ per capita, purchasing-power parity-adjusted US$ per capita, and as a proportion of gross domestic product. We used various models to generate future health spending to 2050. Findings: In 2019, health spending globally reached $8·8 trillion (95% uncertainty interval [UI] 8·7–8·8) or $1132 (1119–1143) per person. Spending on health varied within and across income groups and geographical regions. Of this total, $40·4 billion (0·5%, 95% UI 0·5–0·5) was development assistance for health provided to low-income and middle-income countries, which made up 24·6% (UI 24·0–25·1) of total spending in low-income countries. We estimate that $54·8 billion in development assistance for health was disbursed in 2020. Of this, $13·7 billion was targeted toward the COVID-19 health response. $12·3 billion was newly committed and $1·4 billion was repurposed from existing health projects. $3·1 billion (22·4%) of the funds focused on country-level coordination and $2·4 billion (17·9%) was for supply chain and logistics. Only $714·4 million (7·7%) of COVID-19 development assistance for health went to Latin America, despite this region reporting 34·3% of total recorded COVID-19 deaths in low-income or middle-income countries in 2020. Spending on health is expected to rise to $1519 (1448–1591) per person in 2050, although spending across countries is expected to remain varied. Interpretation: Global health spending is expected to continue to grow, but remain unequally distributed between countries. We estimate that development organisations substantially increased the amount of development assistance for health provided in 2020. Continued efforts are needed to raise sufficient resources to mitigate the pandemic for the most vulnerable, and to help curtail the pandemic for all. Funding: Bill & Melinda Gates Foundation.Mahidol UniversityMedicineArticleSCOPUS10.1016/S0140-6736(21)01258-7