Faced with growing levels of disease from the spread of HIV and AIDS and spiralling costs, healthcare systems in developing countries risk sliding into financial crises unless governments usher in reforms. This is the warning given in a World Bank report.
Figure 1.
A nurse examines a baby at a clinic in Tiangruira, a shanty town in Rio de Janeiro, Brazil
Credit: SEAN SPRAGU/PANOS
International donors must deliver on their promises and boost aid to meet the health needs of the world's poorest people, concludes the report, which assesses the major changes in global health and financing policy that have occurred over the past decade. Between $25bn (£14bn; €20bn) and $70bn a year will be needed to meet the United Nations' millennium development goals for health, says the report.
More money is on the way, affirms one of the authors of the report, George Schieber, but he said, “I hope we don't waste it and [that we] do something for the world's poor.”
The report estimates that over the next 20 years demographic changes will increase total healthcare spending requirements. These range from 14% in Europe and Central Asia to 47% in Latin America and the Caribbean and 62% in the Middle East and North Africa.
Global health spending in 2002 was estimated at $3.2 trillion, or about 10% of the world's combined gross domestic product. But developing countries—with 84% of the world's population and 90% of the disease burden—account for only 12% of global health spending, says the report.
Jean-Louis Sarbib, senior vice president at the World Bank, said, “Poor people in developing countries face almost certain ruin in coping with catastrophic diseases without the financial protection that effective health systems in [wealthy] countries routinely offer.”
In sub-Saharan Africa only 2% of all spending on health by the public is through social insurance, and in South Asia it is only 8%, says the report. And the poorer the country the larger is the amount paid by poor people themselves out of their pockets for health care, it adds.
Aid funds for specific diseases can be effective when poor countries have little money to finance their health budgets, the report says, but it cautions that as their health systems develop this can be a recipe for waste and inefficiency.
“And given the severe human resource constraints in many African countries, aid programs compete with each other to hire away the few skilled professionals needed to run the public health system,” it notes.
Health Financing Revisited: A Practitioner's Guide is available from www.worldbank.org.