The devil is in the data

It is over a week since UHC Forum in Japan and I am just about recovering. So much happened, but I want to highlight three releases that stood out for me: the Global Health Expenditure Database update; SDG 3.8 monitoring report; and the DAH analysis.

If there is one key point to take away – and one that echoes much of the discussion at the UHC Forum – it is that the spotlight is firmly on how countries will pay for UHC. Getting this right is the first step to sustainable progress towards UHC, and many countries can now do this.

1. WHO’s Global Health Expenditure Database revamp

For those health financing geeks out there, this was eagerly anticipated. WHO know how to build suspense, and have made us wait since summer. But the wait was worth it, as WHO launched the updated Global Health Expenditure Database and their analysis of the new data. The System of Health Accounts (SHA-2) is a move towards the data we need to see how countries are progressing to UHC. We can now see in more detail the role of governments, patients, and donors in financing health systems. But most crucially for building financial structures capable of delivering UHC, we can see how much governments spend on domestic resources, with external ‘on-budget’ support being identified for the first time.

This truer figure inevitably paints a worse picture than we previously had. In 2015, the average government spend from domestic resources in low-income countries (LICs) is 1.4% GDP, with sub-Saharan Africa having average of just below 2% GDP. This is well below 5% GDP – the minimum being called for governments to make significant progress towards UHC – and shows just how far many countries must go.

2. SDG 3.8 monitoring report

Ultimately, it will be on data that the success of SDG 3.8 – UHC – will be judged and UHC Day saw the publication of the latest UHC monitoring report. It makes disappointing – but expected – reading. Half of the world’s population still don’t have access to essential health services, and the number of people who spend a quarter of their household budget on health has increased by 5% to 180 million.

This is because public financing is often far too low. And when that is the case, out-of-pocket-spending plugs the gaps, and exposes millions to financial insecurity and impoverishment. This lead myself and others from civil society to repeat the call for governments to spend at least 5% of their GDP on the health sector, with increased focus on primary health and community systems to provide essential health services. In short, the data shows that the world is currently well off-track to meet SDG 3.8. Significant efforts are needed to change this.

3. UK DAH

Looking closer to home, Global Health Advocates launched oda4health.org, which analysed how much aid four European donors are spending on health, and how it’s being spent. The analysis shows that the UK has consistently spent over the 0.1% GNI recommendation. In fact, the UK doubled its aid spend on health between 2008 and 2015, peaking at 0.17% GNI in 2014. What is more, the data shows that the UK spent 100% of aid as grants instead of loans, which has been evenly split between bilateral and multilateral spending. Although – as I have commented before – health has been overtaken as the number one area of UK aid spend. So, a good note to end the year on. Let’s see what 2018 brings.