Abstract

In countries around the world, especially those in which national income is lowest, health improvement is severely hindered by limited resources and weaknesses in their health systems. Moreover, because of the system weaknesses and limited healthcare coverage, public spending is often relatively pro-rich.

This means important interventions are often not provided for those who could benefit the most, when and where they need them. Taking Africa as one example, the continent faces 23% of the global disease burden, yet accounts for <1% of total global health expenditures.

Other low- and middle-income regions, such as Latin America, South Asia, and Eastern Mediterranean, face similar challenges. Improved resource allocation to and within the health systems therefore has huge potential to improve population health and reduce health inequalities as it affects life and death. Congruently, misplaced health spending results in large forgone opportunities to improve population health. For example, £1000 of misplaced expenditure would lead to 22 quality-adjusted life-years (QALYs) lost in Malawi, compared with only 0.1 QALY in the United Kingdom.