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The JLN Dashboard on Health Financing for Universal Health Coverage (UHC)

The JLN Domestic Resource Mobilization (DRM) Collaborative Dashboard on Health Financing for UHC provides graphical depictions of the effects of the COVID 19 pandemic on health financing in a subset of JLN countries using public sources.

Universal health coverage (UHC), the notion that 'all individuals and communities receive the health services they need without suffering financial hardship,' is a key Sustainable Development Goal for 2030, and domestic public resources play a central role in making progress towards UHC. The Covid-19 pandemic has brought the importance of strong health systems to the center stage, though it also influences the availability of adequate domestic resources needed for making progress towards UHC through various pathways. The DRM Dashboard depicts pre-and post-pandemic health financing indicators. It considers the drivers for changes in domestic General Government Health Expenditure (GGHED) between 2013 and 2018, and the effects of the COVID-19 Pandemic on Post-Pandemic for health financing and UHC attainment.

The metrics depicted in the Dashboard can be combined with DRM collaborative products to make the case for investment in health. These include the Making the Case for Health: A Messaging Guide for Domestic Resource Mobilization for Health and the Narrative Summaries on Public Expenditure for Health.

Select Country -

Country Overview

General Country Information (2020)

Population
GDP per capita
Gross National Income (GNI) per capita

Revenue and Debt (2020)

General Government Revenue.
Share of GDP
General Government Net Debt.
Share of GDP

Note: IDA also supports some countries, including several small island economies, that are above the operational cutoff but lack the creditworthiness needed to borrow from the IBRD. Reference: World Bank.
Source: World Bank, World Development Indicators, IMF World Economic Outlook (October 2021).

The Pre-Pandemic Health Financing for Universal health coverage (UHC) Context.

Current Health Expenditure (CHE) Against Gross National Income (GNI) per Capita, 2018.

Is the country’s spending on health commensurate with its economic development? Current health expenditure, which excludes capital expenditure but includes external and private financing, generally increases with income status as indicated by the red fitted line. This chart visualises the country’s overall health spending locus given its income status, and its recent trajectory.

Composition of Health Financing Sources, 2018.

General Government Health Expenditure (GGHE) Share of Current Health Expenditure (CHE) Against Gross National Income (GNI) per Capita, 2018.

Is the country’s share of government spending on health commensurate with its economic development? The share of government spending on health generally increases with income status as indicated by the red fitted line. This chart visualises the country’s government share of health spending given its income status, and its recent trajectory.

Indexed Real General Government Health Expenditure (GGHE) per Capita, 2000-2018.

How has general government health expenditure changed since 2000, correcting for population growth and inflation? Such spending is critical for to attain Universal health coverage (UHC) equitably and effectively.

What Drove Changes in Domestic General Government Health Expenditure (GGHED) between 2013-2018?

Real GDP growth per capita
Pre-pandemic 2013-2018; CAGR
+0.4% from 2019
General government expenditures as a proportion of GDP.
Pre-pandemic 2013-2018; Average annual percentage point change.
Domestic General Government Health Expenditure (GGHED) as a proportion of general government expenditures.
Pre-pandemic 2013-2018; Average annual percentage point change.

External Health Expenditure as a Share of Current Health Expenditure (CHE) Against Gross National Income (GNI) per Capita, 2018.

How dependent is the country on external development assistance for health? As income status increases, countries generally rely much less on external financing, but there remains considerable inter-country variation even despite adjusting for income status.

Out-of-pocket (OOP) Health Expenditure as a Share of Current Health Expenditure (CHE) Against Gross National Income (GNI) per Capita, 2018.

Were health expenditures adequately pooled? After a certain level of economic development, the share of out-of-pocket expenditures generally increases with income status as indicated by the red fitted line. This chart visualises the country’s government share of health spending given its income status, and its recent trajectory.

Exposure to Catastrophic or Impoverishing Health Expenditures.

Out-of-pocket share of health expenditures does not capture the incidence (“who”) nor the content (“what”) these expenditures were incurred for — hence the need to include household-level indicators. Household catastrophic health expenditures are the key SDG 3.8.2 health financing indicator.
Note: Decreased exposure to catastrophic or impoverishing health expenditures may also be due to unmet needs for healthcare.

Universal health coverage (UHC) Service Coverage Index and GGHE per Capita, 2018.

General government health expenditure is critical for Universal health coverage (UHC) as it is widely pooled (from rich to poor; healthy to sick) and can prioritise effective health programs, but some countries may over and underperform relative to health finances committed. This indicator allows a country to place itself comparatively with respect to the performance of other countries.

Financial Protection and Out-of-pocket (OOP), 2018.

As OOP health expenditures fall, financial protection is enhanced, but some countries may appear to over and underperform due to distributional issues (i.e. if OOP is concentrated among the wealthy).

The Covid-19 Pandemic.

Deaths, Confirmed Cases, and Moblity, Q1 2020 to Present.

The direct impact of the Covid-19 pandemic on Covid-19 mortality and morbidity provide an indication of the resilience of the health system and potential damage sustained. However, the pandemic also will affect health financing and Universal health coverage (UHC) due to responses taken, such as lockdowns, which result in an economic crises and decreased government revenues.

Source:
  - Hannah Ritchie, Esteban Ortiz-Ospina, Diana Beltekian, Edouard Mathieu, Joe Hasell, Bobbie Macdonald, Charlie Giattino, Cameron Appel, Lucas Rodés-Guirao and Max Roser. (2020) - "Coronavirus Pandemic (COVID-19)". Published online at OurWorldInData.org.
  - Google LLC "Google COVID-19 Community Mobility Reports". google.com/covid19/mobility/
Post-Pandemic for Health Financing and Universal health coverage (UHC).

Pre-pandemic vs Latest Projections for Domestic General Government Health Expenditure (GGHE).

Changes in projections of the domestic portion of general government health expenditures, based on an assumption of an unchanged share of health allocations from general government expenditures, from before the pandemic (October 2019) to the latest available IMF estimates (October 2021) are used to provide a leading indicator of the emerging impact of the pandemic on health financing in the medium term.

Progress Made with Covid-19 Vaccinations.

A robust exit from the pandemic and socioeconomic reopening will almost certainly need to be underpinned by herd immunity achieved through vaccinations.

The World Bank’s support to the JLN DRM Collaborative is made possibly with financial contributions from the following partners:

Source:
  - Global Health Expenditure Database
  - World Economic Outlook
  - GGHED projections based on Scenario 2 (Status quo priority to health) [ Kurowski, Christoph; Evans, David B; Tandon, Ajay; Eozenou, Patrick Hoang-Vu; Schmidt, Martin; Irwin, Alec; Salcedo Cain, Jewelwayne; Pambudi, Eko Setyo; Postolovska, Iryna. 2021. From Double Shock to Double Recovery : Implications and Options for Health Financing in the Time of COVID-19. Health, Nutrition and Population Discussion Paper;. World Bank, Washington, DC. © World Bank. https://openknowledge.worldbank.org/handle/10986/35298 License: CC BY 3.0 IGO ] but updated with IMF WEO October 2021 projections;
  - Hannah Ritchie, Esteban Ortiz-Ospina, Diana Beltekian, Edouard Mathieu, Joe Hasell, Bobbie Macdonald, Charlie Giattino, Cameron Appel, Lucas Rodés-Guirao and Max Roser. (2020) - "Coronavirus Pandemic (COVID-19)". Published online at OurWorldInData.org.