The World Health Organisation (WHO) has released its 2023 global health expenditure report, bringing attention to the patterns of global health spending amid the ongoing COVID-19 pandemic.

Published just ahead of Universal Health Coverage (UHC) Day, the report discloses that, in 2021, global health spending reached an unprecedented $9.8 trillion, constituting 10.3% of the global gross domestic product (GDP).

However, underscoring the stark inequality in the distribution of health spending, the report pointed out that while public health spending increased globally, low-income countries experienced a decline in government health expenditure, relying heavily on external health aid.

While 11% of the world's population in 2021 spent less than $50 per person annually. This underscores the disparities in health spending per capita, which is approximately $4,000 in high-income countries.

Dr Bruce Aylward, WHO Assistant Director-General for Universal Health Coverage, Life Course, emphasised in a statement the urgent need for sustained public financing in health, especially in the face of current challenges like the climate crisis and conflicts. He highlighted the importance of resilient health systems that can withstand various shocks while protecting people's health and well-being.

According to the report, hospitals, ambulatory care providers, and pharmacies account for 65%–84% of health spending across all income groups, according to disaggregated data from health service providers from 50 countries. Notably, preventive care providers spent more than other types of providers.

In a significant revelation this year, the report focused on capital investments in health, crucial for the continued functioning of health systems.

It found that, unlike daily resource consumption reflected in current health spending, capital investments involve creating new assets, such as buildings and equipment. Throughout the pandemic, all income groups experienced an increase in capital investments, and low-income countries, in particular, saw a surge in spending on machinery and equipment, likely influenced by the initial shortage of essential equipment.

In its recommendation, the report advocated for improved data collection and use, emphasising the role of the global health expenditure database (GHED) as a global public good.

It may be noted that the GHED provides essential information for policy development, national planning, and monitoring, promoting transparency and accountability in the government's use of public funds for health.

Interestingly, this year's report introduces health expenditure data by health care providers, aiming to enhance understanding of resource flows and guide future investments in health with a primary health care (PHC) approach.

The report calls for action to improve data quality, availability, and timeliness, urging the countries to adopt health account practices in line with the global standard for the System of Health Accounts framework.

It may be recalled that Oxfam India's Inequality Report 2021 shed light on the growing socio-economic disparities in India, particularly how these disparities disproportionately impact the health outcomes of marginalised groups as a result of non existence of Universal Health Coverage (UHC). 

The report, which provided a comprehensive analysis of health outcomes across different socioeconomic groups, underscores alarming trends.

According to the data presented, 65.7 percent of households in the General Category have access to improved, non-shared sanitation facilities, compared to only 25.9 percent in Scheduled Tribes (ST) households. 

Moreover, children in Scheduled Castes (SC) households are 12.6 percent more likely to be stunted than those in general category households. Additionally, the likelihood of a child dying before the age of five is three times higher for the bottom 20 percent of the population compared to the top 20 percent.

The report futher pointed out that ito healthcare access and access to food supplements under ICDS based on religious lineswhich had further intensified during the COVID-19 pandemic, exacerbating existing disparities.

The report highlighted the inadequacies in India's public healthcare system, exemplified by the disastrous second wave of the COVID-19 pandemic. The number of government allopathic doctors and state-run hospitals per population remains significantly low, contributing to the weaknesses exposed during the pandemic.

The underfunding of the public healthcare system over the last decade has also led to a decline in health infrastructure. The number of hospital beds per 10,000 population has reduced from 9 to 5 between 2010 and 2020. India currently ranks 155 out of 167 countries in bed availability, with rural India, housing 70 percent of the population, having only 40 percent of the country's beds.

The report emphasisd the need for Universal Health Coverage (UHC) supported by a robust public health sector to address fundamental health inequalities while recommending addressing Out-of-Pocket expenditure (OOPE) on health, which pushes six crore people into poverty every year, according to government estimates.