Government health spending in low- and lower-middle-income countries remains below the levels needed to achieve universal health coverage, according to a new report from the Government Resources and Projections for Health (GRPH) Series. The analysis highlights ongoing challenges as these countries face economic uncertainty and significant reductions in external aid.
The report finds that government and donor spending on health in 2024 is less than one-third of the $60 per capita benchmark required in low-income countries, and about half of the $90 benchmark for lower-middle-income countries. Spending has stagnated since 2018, with progress toward universal health coverage slowing since 2015.
Looking ahead, projections suggest that most low-income countries and many lower-middle-income countries will see a decline in combined government and donor health spending by 2030. While government health expenditure is expected to grow by 14% in low-income countries and 17% in lower-middle-income countries between 2024 and 2030, this growth will not be enough to close the financing gap for universal health coverage. The report notes that cuts to development assistance for health—projected to decrease by around 20%—will offset gains from increased government spending.
The report states: "Doubling down on efficiency—by prioritizing primary healthcare, aligning remaining development assistance with domestic priorities, and improving budget execution—can help resources go further. Aid-dependent countries have a reform window to restructure their health systems as aid dwindles."
However, it also emphasizes that efficiency improvements alone are insufficient. "Progress also requires spending more and it is feasible to raise the share of government spending for health in a third of LICs and LMICs; they have the fiscal space and underprioritize health compared to peers. Countries can also raise taxes on unhealthy products and undertake broader macro-fiscal reforms to create fiscal space," according to the report.
The GRPH Series provides an annual assessment of how ambitions for universal health coverage compare with actual government health spending in low- and lower-middle income nations. It supports efforts aligned with the World Bank’s target of providing affordable, quality health services to 1.5 billion people by 2030.