A new report from the World Bank Group highlights that low-income countries spent an average of only $17 per person on health in 2024. This figure is less than a third of the estimated $60 needed to provide a basic package of essential health services. Lower-middle income countries spent $47 per capita, which is just over half the recommended benchmark of $90.
The report, titled "At a Crossroads: Prospects for Government Health Financing Amidst Declining Aid," notes that spending on health has remained flat in real terms since 2018. As a result, there are fewer resources for critical areas such as antenatal care, vaccines, and frontline healthcare workers. The most vulnerable populations are at risk of falling deeper into poverty due to out-of-pocket expenses or lack of access to care.
“This report is a reminder that while progress is possible, it requires continued commitment and collaboration,” said Mamta Murthi, Vice President for the People Vice Presidency at the World Bank Group. “Reaching 1.5 billion more people with essential health services by 2030 will take a shared effort—through smarter investments, more domestic financing, and deeper partnerships between governments, the private sector, and development partners.”
The outlook for health financing in low- and lower middle-income countries remains challenging as development assistance for health (DAH) is expected to decline over the next five years. Although government spending on health may rise in about two-thirds of these countries, overall resources could fall due to reductions in donor funding. By 2030, projections indicate that more than 80% of low-income countries and 40% of lower-middle income countries will have less combined government and donor spending on health compared to 2024.
Countries are encouraged to make efficient use of available resources by focusing on primary healthcare and improving budget execution. Aligning donor support with national priorities can also help achieve better outcomes without increasing current government spending levels. Additionally, about one-third of all countries already have room within their budgets to increase public spending on health.
The report suggests expanding fiscal space through economic growth and stronger domestic revenue collection. Reallocating funds from inefficient subsidies could also allow greater investment in priority areas like health.
Collaboration among governments and partners will be important to ensure that financing strategies remain relevant both now and in the future. The World Bank's Health Works initiative supports nations in creating country-specific plans aimed at reforming their healthcare systems.
On December 6th, global leaders will gather at the Universal Health Coverage High-level Forum in Tokyo—a meeting hosted by Japan with co-conveners including the World Bank Group and World Health Organization—to discuss progress toward universal access to quality healthcare.
"At a Crossroads" launches an annual series from the World Bank designed to track government spending trends on health across low- and lower-middle income nations.