38 billion in health financing in 2020. What does TOSSD show on health expenditures?


The COVID-19 pandemic has underscored the need for increased, more targeted global investments in the health components of the Sustainable Development Goals (SDGs).

How much external financing do developing countries receive for health? How do developing countries co-operate with each other to strengthen their health capacities? How much support go to international public goods, such pandemic preparedness and response? Are public investments in health R&D aligned to the need to provide fair and global access to health technologies? These are key public policy questions that need an integrated, coherent, global response.

The Total Official Support for Sustainable Development (TOSSD) measure fills some of these information gaps.

TOSSD tracks cross-border resource flows to developing countries as well as regional and global expenditures for sustainable development. The second TOSSD data collection, on 2020 activities, was a step further towards answering some key global health policy questions.

2020 Health figures

In 2020, the provider countries and organisations that report to TOSSD disbursed a total of USD 38 billion for health. Cross-border support to developing countries represented 78% (USD 30 billion) of this amount. 22% (USD 8 billion), supported global and regional expenditures for health-related international public goods (e.g. global health research or the development of global health norms). On cross-border flows, 48% were spent on basic health, in particular basic health care and infectious disease control, and 32% on reproductive health, mainly for the control of sexually-transmitted diseases (STDs) and HIV/AIDS.

Non-communicable diseases (NCDs) represented only 1% of these expenditures. Perceived as “rich-country” diseases and underfunded by development co-operation, 77% of all NCD deaths take place in low- and middle-income countries nowadays. The challenge that NCDs represent is reflected in SDG target 3.4, which calls for reducing “by one-third premature mortality from non-communicable diseases through prevention and treatment”. While still lagging behind, international co-operation to address NCDs is stepping up. Also, new financing initiatives are in place, such as the United Nations multi-partner trust fund on non-communicable diseases and mental health. TOSSD will show over the next years whether these efforts will trigger a broader international financial response that is commensurate with the challenge represented by NCDs.

And, what about pandemics control?

COVID-19 made the international community’s attention drawn to pandemic preparedness and response. According to TOSSD, governments and multilateral organisations disbursed USD 21.5 billion aimed at controlling pandemics and infectious diseases. On diseases, while COVID-19 control was of course a major focus with 25% of the total, it ranked only second after STD and HIV/AIDS control (39%). TOSSD tracked around USD 1 billion USD for research related to infectious diseases, 80% of which was COVID-19-related.

The fight against pandemics requires both country-level and global capacities. Of the 21.5 billion to control pandemics and infectious diseases, 79% supported developing countries, while 21% supported global and regional activities, such as global health surveillance or health R&D.

How did developing countries co-operate through South-South co-operation for health?

TOSSD helps to close data gaps on South-South Co-operation's contribution to health support. In 2020, SSC providers reporting to TOSSD disbursed USD 87 million and committed USD 563 million for health-related expenditures. A key feature of south-south co-operation is technical exchange and in-kind donations. Expressed in number of activities, there were 419 SSC activities related to health. Some of these include donations of medical supplies, training for health staff, sanitary services, and support for health policy-making and reform.

What’s still missing in TOSSD and what’s next?

While TOSSD is answering some key global health questions, it is still, and will continue to be, work in progress. TOSSD’s data coverage has not yet reached its full potential, but this will be enhanced over the next few years. TOSSD has improved the coverage of SSC in international development finance statistics but some major health SSC providers are still missing. Furthermore, tracking domestic support to international public goods is a new and challenging task for reporters who will need time to build their data collection capacity.

An important question is whether global R&D investments help provide fair and global access to health technologies. While TOSSD has set guidance on reporting R&D expenditures, work is still ongoing at the TOSSD Task Force on further refining these criteria. The Task Force is also discussing more targeted tracking methods for pandemic preparedness and response. Other global health issues that will need to be better tracked include poverty-related neglected diseases, rare diseases or anti-microbial resistance. Finally, discussions are also ongoing at the TOSSD Task Force on how to link TOSSD with other key health financing databases, such as the G-Finder of global funding for global health R&D and the OECD and WHO System of Health Accounts (SHA).  

Publication date: 5 December 2022

Author: TOSSD Task Force Secretariat


Related Documents