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1
The ongoing COVID-19 pandemic has shown that public financial management (PFM) should be an integral part of the response. Effectiveness in financing the health response depends not only on the level of funding but also on the way public funds are allocated and spent, this is determined by the PFM r
...
ules, and how money flows to health service providers. So far, early assessments have shown that PFM systems ranged from being a fundamental enabler to acting as a roadblock in the COVID-19 health response. While service delivery mechanisms have been extensively documented throughout the pandemic, the underlying PFM mechanisms of the response also merit attention. To highlight the importance of PFM in health emergency contexts, this rapid review analyses various country PFM experiences and identifies early lessons emerging from the financing of the health response to COVID-19. The assessment is done by stages of the budget cycle: budget allocation, budget execution, and budget oversight. Identifying lessons from the varying PFM modalities used to finance the response to COVID-19 is fundamental both for health policy-makers and for finance authorities to prepare for future health emergencies.
more
A general consensus exists that as a country develops economically, health spending per capita rises and the share of that spending that is prepaid through government or private mechanisms also rises. However, the speed and magnitude of these changes vary substantially across countries, even at simi
...
lar levels of development. In this study, we use past trends and relationships to estimate future health spending, disaggregated by the source of those funds, to identify the financing trajectories that are likely to occur if current policies and trajectories evolve as expected.
Methods
We extracted data from WHO's Health Spending Observatory and the Institute for Health Metrics and Evaluation's Financing Global Health 2015 report. We converted these data to a common purchasing power-adjusted and inflation-adjusted currency. We used a series of ensemble models and observed empirical norms to estimate future government out-of-pocket private prepaid health spending and development assistance for health. We aggregated each country's estimates to generate total health spending from 2013 to 2040 for 184 countries. We compared these estimates with each other and internationally recognised benchmarks.
Findings
Global spending on health is expected to increase from US$7·83 trillion in 2013 to $18·28 (uncertainty interval 14·42–22·24) trillion in 2040 (in 2010 purchasing power parity-adjusted dollars). We expect per-capita health spending to increase annually by 2·7% (1·9–3·4) in high-income countries, 3·4% (2·4–4·2) in upper-middle-income countries, 3·0% (2·3–3·6) in lower-middle-income countries, and 2·4% (1·6–3·1) in low-income countries. Given the gaps in current health spending, these rates provide no evidence of increasing parity in health spending. In 1995 and 2015, low-income countries spent $0·03 for every dollar spent in high-income countries, even after adjusting for purchasing power, and the same is projected for 2040. Most importantly, health spending in many low-income countries is expected to remain low. Estimates suggest that, by 2040, only one (3%) of 34 low-income countries and 36 (37%) of 98 middle-income countries will reach the Chatham House goal of 5% of gross domestic product consisting of government health spending.
Interpretation
Despite remarkable health gains, past health financing trends and relationships suggest that many low-income and lower-middle-income countries will not meet internationally set health spending targets and that spending gaps between low-income and high-income countries are unlikely to narrow unless substantive policy interventions occur. Although gains in health system efficiency can be used to make progress, current trends suggest that meaningful increases in health system resources will require concerted action.
Funding
Bill & Melinda Gates Foundation.
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Tanzania, like other developing countries, is facing a higher burden of cardiovascular diseases (CVDs). The country is experiencing rapid growth of modifiable and intermediate risk factors that accelerate CVD mortality and morbidity rates. In rural and urban settings, cardiovascular risk factors suc
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h as tobacco use, excessive alcohol consumption, unhealthy diet, hypertension, diabetes, hyperlipidemia, overweight, and obesity, are documented to be higher in this review. Increased urbanization, lifestyle changes, lack of awareness and rural to urban movement have been found to increase CVD risk factors in Tanzania. Despite the identification of modifiable risk factors for CVDs, there is still limited information on physical inactivity and eating habits among Tanzanian population that needs to be addressed. Conclusively, primary prevention, improved healthcare system, which include affordable health services, availability of trained health care providers, improved screening and diagnostic equipment, adequate guidelines, and essential drugs for CVDs are the key actions that need to be implemented for cost effective control and management of CVDs. Effective policy for control and management of CVDs should also properly be employed to ensure fruitful implementation of different interventions.
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In 2015, the United Nations set important targets to reduce premature
cardiovascular disease (CVD) deaths by 33% by 2030. Africa disproportionately
bears the brunt of CVD burden and has one of the highest risks of dying
from non-communicable diseases (NCDs) worldwide. There is currently
an epide
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miological transition on the continent, where NCDs is projected
to outpace communicable diseases within the current decade. Unchecked
increases in CVD risk factors have contributed to the growing burden of three
major CVDs—hypertension, cardiomyopathies, and atherosclerotic diseasesleading to devastating rates of stroke and heart failure. The highest age
standardized disability-adjusted life years (DALYs) due to hypertensive heart
disease (HHD) were recorded in Africa. The contributory causes of heart failure
are changing—whilst HHD and cardiomyopathies still dominate, ischemic
heart disease is rapidly becoming a significant contributor, whilst rheumatic
heart disease (RHD) has shown a gradual decline. In a continent where health
systems are traditionally geared toward addressing communicable diseases,
several gaps exist to adequately meet the growing demand imposed by CVDs.
Among these, high-quality research to inform interventions, underfunded
health systems with high out-of-pocket costs, limited accessibility and
affordability of essential medicines, CVD preventive services, and skill
shortages. Overall, the African continent progress toward a third reduction
in premature mortality come 2030 is lagging behind. More can be done in
the arena of effective policy implementation for risk factor reduction and
CVD prevention, increasing health financing and focusing on strengthening
primary health care services for prevention and treatment of CVDs, whilst
ensuring availability and affordability of quality medicines. Further, investing
in systematic country data collection and research outputs will improve the accuracy of the burden of disease data and inform policy adoption on
interventions. This review summarizes the current CVD burden, important
gaps in cardiovascular medicine in Africa, and further highlights priority
areas where efforts could be intensified in the next decade with potential
to improve the current rate of progress toward achieving a 33% reduction
in CVD mortality.
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Diabetes mellitus is a leading cause of mortality and reduced life expectancy. We aim to estimate the burden of diabetes by type, year, regions, and socioeconomic status in 195 countries and territories over the past 28 years, which provide information to achieve the goal of World Health Organizatio
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n Global Action Plan for the Prevention and Control of Noncommunicable Diseases in 2025. Data were obtained from the Global Burden of Disease Study 2017. Overall, the global burden of diabetes had increased significantly since 1990. Both the trend and magnitude of diabetes related diseases burden varied substantially across regions and countries. In 2017, global incidence, prevalence, death, and disability-adjusted life-years (DALYs) associated with diabetes were 22.9 million, 476.0 million, 1.37 million, and 67.9 million, with a projection to 26.6 million, 570.9 million, 1.59 million, and 79.3 million in 2025, respectively. The trend of global type 2 diabetes burden was similar to that of total diabetes (including type 1 diabetes and type 2 diabetes), while global age-standardized rate of mortality and DALYs for type 1 diabetes declined. Globally, metabolic risks (high BMI) and behavioral factors (inappropriate diet, smoking, and low physical activity) contributed the most attributable death and DALYs of diabetes. These estimations could be useful in policy-making, priority setting, and resource allocation in diabetes prevention and treatment.
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Since the Alma Ata Declaration in 1978, community health volunteers (CHVs) have been at the forefront, providing health services, especially to underserved communities, in low-income countries. However, consolidation of CHVs position within formal health systems has proved to be complex and continue
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s to challenge countries, as they devise strategies to strengthen primary healthcare. Malawi’s community health strategy, launched in 2017, is a novel attempt to harmonise the multiple health
service structures at the community level and strengthen service delivery through a team-based approach. The core community health team (CHT) consists of health surveillance assistants (HSAs), clinicians, environmental health officers and CHVs. This paper reviews Malawi’s strategy, with particular focus on the interface between HSAs, volunteers in community-based programmes and
the community health team. Our analysis identified key challenges that may impede the strategy’s implementation:
(1) inadequate training, imbalance of skill sets within CHTs and unclear job descriptions for CHVs; (2) proposed community-level interventions require expansion of pre-existing roles for most CHT members; and (3) district authorities may face challenges meeting financial obligations and filling community-level positions. For effective implementation, attention and further deliberation is needed on the appropriate forms of CHV support, CHT composition with possibilities of co-opting trained CHVs
from existing volunteer programmes into CHTs, review of CHT competencies and workload, strengthening coordination and communication across all community actors, and financing mechanisms. Policy support through the development of an addendum to the strategy, outlining opportunities for task-shifting between CHT members, CHVs’ expected duties and interactions with paid CHT personnel is recommended.
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Malaria remains a significant public health concern in the SADC region, accounting for 20% of childhood deaths, as well as prompting numerous outpatient visits and hospitalisations. Around three-quarters of the population, including 35 million children under the age of five and 8.5 million pregnant
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women, are at risk. Transmission patterns vary from high and stable in the north to malaria-free in the south, with low, unstable and seasonal zones in between. Although interventions such as indoor residual spraying (IRS), insecticide-treated nets (ITNs/LLINs), intermittent preventive treatment in pregnancy (IPTp), rapid diagnostic tests (RDTs), and artemisinin-based combination therapies (ACTs) have reduced the malaria burden, challenges persist in terms of funding, human resources, surveillance, and cross-border coordination. Achieving malaria elimination in the SADC region requires harmonised regional standards, strengthened surveillance, and improved access to quality treatment and policy prioritisation.
Accessed on 27/08/2025.
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The effective vaccine management (EVM) workshop, jointly organized by WHO and UNICEF, was attended by participants from 13 countries, who reviewed the various EVM benchmarks, identified the gaps in policies, guidelines, SOPs and job aids, and developed respective country action plans to fill these g
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aps. This meeting report outlines the proceedings and outcomes of the workshop conducted in Bangkok, Thailand, in December 2024
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Getting on track to end AIDS as a public health threat by 2030. This new Road Map charts a way forward for country-level actions to achieve an ambitious set of HIV prevention targets by 2025. Those targets emerged from the 2021 Political Declaration on HIV and AIDS, which the United Nations General
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Assembly adopted in June 2021 and they are underpinned by the Global AIDS Strategy (2021–2026). The Strategy sets out the principles, approaches, priority action area and programmatic targets for the global HIV response
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The Public Health Burden of Secondhand Exposure to Commercial Tobacco Smoke Secondhand smoke, the combination of smoke from burning commercial tobacco* products and the smoke breathed out by a person who is smoking, is deadly.
The third Malawi Growth and Development Strategy (MGDS III) has been formulated following the expiry of its predecessor strategy, MGDS II, in June 2016. The strategy has been prepared at a time when Malawi has been experiencing multiple shocks including floods, drought and financial crises. While fo
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od production improved in 2017, the cycle of food deficit and surplus has kept the country preoccupied with fighting disasters instead of pursuing its development agenda. It is for this reason that the theme of the MGDS III is "Building a Productive, Competitive and Resilient Nation". With this theme, the Government of Malawi undertakes to support Malawi's development into a productive nation competing on the global stage while ensuring that the nation builds systems that deal with natural shocks and disasters.
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The HIV/AIDS Sustainability Index Dashboard is a tool completed every two years by President’s Emergency Plan for AIDS Relief (PEPFAR) teams, host government and partner stakeholders to sharpen the understanding of each country’s sustainability landscape and to assist PEPFAR and other donors in
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making informed HIV/AIDS investment decisions. Based on responses to more than 100 questions, the SID assesses the current state of sustainability of national HIV/AIDS responses across 17 critical elements. Scores for these elements are displayed on a color-coded dashboard, together with contextual charts and information. As the SID is completed over time,
it will allow stakeholders to track progress and gaps across these key components of financial and programmatic sustainability.
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Malawi Internationally recommended key policies uptake
Step Up for TB 2020 Tuberculosis Policies in 37 Countries A survey of prevention, testing, and treatment policies and practices.
The country scorecard reflects how many of 14 internationally recommended key policies are in place at the national level, based on the Step Up for TB 2020 report survey
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.
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Keeping active can help people stay at a healthy weight, avoid many chronic health problems, and reduce stress and boost mood.
Despite all its benefits, about one in three people globally gets too little, if any, physical activity.
The article on the PAHO website discusses the health risks of excessive salt consumption, which contributes to numerous deaths worldwide. It highlights that average salt intake significantly exceeds WHO recommendations, particularly in the Americas, and suggests measures like reducing salt in foods
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and implementing clear nutritional labeling to prevent diseases.
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Tobacco kills up to half of its users who don’t quit (1-3).
Tobacco kills more than 8 million people each year, including an estimated 1.3 million non-smokers who are exposed to second-hand smoke Around 80% of the world's 1.3 billion tobacco users live in low- and middle-income countries.In 2020,
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22.3% of the world’s population used tobacco: 36.7% of men and 7.8% of women.
To address the tobacco epidemic, WHO Member States adopted the WHO Framework Convention on Tobacco Control (WHO FCTC) in 2003. Currently 182 countries are Parties to this treaty.
The WHO MPOWER measures are in line with the WHO FCTC and have been shown to save lives and reduce costs from averted healthcare expenditure.
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The Government of Malawi is committed to improving health and livelihoods in Malawi through community health – the
provision of basic health services in rural and urban communities with the participation of people who live there.
Historically, Community Health has significantly contributed to im
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provements in Malawi’s health outcomes in particular
attainment of MDG4. However, the community health system faces resource constraints and inconsistencies around quality
of service – which negatively affect health outcomes.
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Evidence shows that oral pre-exposure prophylaxis (PrEP) reduces the risk of contracting HIV during sexual intercourse by more than 90% when taken daily. It is for this reason the National HIV Prevention Strategy 2015-2020 (2018 Revision) emphasises the role of preexposure prophylaxis (PrEP) in
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reducing new HIV infections in Malawi.
The Ministry of Health has prioritised PrEP use among the populations most at-risk of HIV infection in Malawi: young women ages 10 to 24 years, sero-discordant couples, female sex workers, men who have sex with men, and other priority populations (such as members of the uniformed services, prisoners, and mobile populations).
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The Country Cooperation Strategy is the World Health Organization (WHO)’s reference for country work guiding planning and resource allocation through alignment with national health priorities and harmonization with other development partners. It clarifies roles and functions of WHO in supporting t
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he national strategic plan for health through the Sector-Wide Approach and Malawi Growth and Development Strategy II. The Country Cooperation Strategy is based on a systematic assessment of the recent national achievements, emerging health needs,
challenges, government policies and expectations. An evaluation of the previous CCS was conducted and jointly discussed with the Ministry of Health as well as other key stakeholders. This process led to the identification of the, achievements, challenges and shortfalls of the previous CCS. Through this process the areas where WHO needed to focus on were also identified. The CCS development has also been done in parallel with the formulation of the new Health Sector Strategic Plan (HSSP) to ensure that there is a linkage between the two.
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