Table 6:

Potential funding sources for expanding fiscal space for health and investment in scale-up of imaging diagnostics and cancer care in low-income and middle-income countries

Potential funding source	Potential additional fiscal space that could be created	Feasibility of creating additional fiscal space	Suitability for funding scale-up of imaging diagnostics for cancer
Improved economic growth.	Substantial. Could help increase each year per capita government spending on health by around 5.3% in upper-middle-income countries, 4.2% in middle-income countries and 1.8% in low-income countries.64	Feasible. LMICs are projected to achieve robust economic growth.63 despite COVID-19 many have returned to positive growth trajectories. (see footnote)	Would generate sustainable general revenue income for allocation to health.
Generation of revenues by strengthening tax administration	Allocating at least one-third of newly raised revenues to health, could on average increase public expenditure on health in low-income and middle-income countries by 78% (95% CI 60-90%).66	Feasible. Tax revenues in LMICs are 15-30% of GDP compared to 40% in high-income countries but would require stronger tax collection systems that would take time to implement.65	Additional revenues would need to be allocated to health. Sustainable funding.
Increased taxes on tobacco, alcohol and sugary beverages	Substantial. In low-income countries 50% increase in tobacco prices could generate on average additional revenue of 0.17% of GDP each year.68	Feasible, but would require political will to fight opposition. Highly cost-effective.67	Sustainable funding with additional health and economic benefits. Could be earmarked for health.
Reprioritization of health within government budget	Substantial. In LMICs could increase funds allocated to health by 72% (95% CI, 57-87%).66	Would require strong political capital to achieve reprioritization.	Sustainable funding.
Borrowing from domestic and international sources and ODA	Substantial, but under-utilized. Could be in the form of hybrid financing – mix of loan and equity from public and private sectors.	Feasible. Low interest rates make this an attractive option. Infrastructure loans available from World Bank and Regional Development Banks. Export guarantees would substantially reduce borrowing costs.69,70,72,71	Encourage public-private partnerships to reduce capital investment requirements for government. Could provide revenue stream to investors to offset costs.
Innovative financing	Substantial. Large potential.	Social or Development Impact Bonds could be used to invest in scale up.74,75,76 Easily measurable results with investment in imaging diagnostics.	Encourage public-private partnerships to reduce capital investment requirements for government. Provides revenue stream to investors to offset costs.

Sources for Table 6: Authors’ analysis synthesis of evidence from references in table and the International Monetary Fund 2020 report, “World Economic Outlook: A Long and Difficult Ascent.”⁷⁷