投资健康：财政转向的途径（英）2025

© 2025International Bank for Reconstruction and Development / The World Bank1818 H Street NWWashington DC 20433Telephone: 202-473-1000Internet: www.worldbank.org This work is aproduct of the staff of The World Bank with external contributions. The findings, interpretations,and conclusions expressed in this work do not necessarily reflect the views of The World Bank, its Board ofExecutive Directors, or the governments they represent. The World Bank does not guarantee the accuracy, completeness, or currency of the data included in this workand does not assume responsibility for any errors, omissions, or discrepancies in the information, or liabilitywith respect to the use of orfailure to use the information, methods, processes, or conclusions set forth. Theboundaries, colors, denominations, links/footnotes and other information shown in this work do not imply anyjudgment on the part of The World Bank concerning the legal status of any territory or the endorsement oracceptance of such boundaries. The citation of works authored by others does not mean the World Bankendorses the views expressed by those authors or the content of their works. Nothing herein shall constitute or be construed or considered to be a limitation upon or waiver of the privilegesand immunities of The World Bank, all of which are specifically reserved. Rights and Permissions The material in this work is subject to copyright. Because The World Bank encourages dissemination of itsknowledge, this work may be reproduced, in whole or in part, for noncommercial purposes as long as fullattribution to this work is given. Any queries on rights and licenses, including subsidiary rights, should be addressed to World Bank Publications,The World Bank Group, 1818 H Street NW, Washington, DC 20433, USA; fax: 202-522-2625; e-mail:pubrights@worldbank.org. Investing in Health: Pathways for a Fiscal Pivot Abstract This paper examines how low-and lowermiddle-income countries(LLMICs)can expand government healthspending to accelerate progress towardUniversalHealthCoverage and other health-relatedSustainableDevelopment Goals.Despite long-term gains,growth in government health spending has markedly slowed,and many LLMICs facetightening fiscal space, declining external support, and rising competition for publicresources.Pathways for aFiscalPivot sets out an agenda to expand government health spending across budgettransfers, social contributions, and development assistance for health, combining political economy strategieswith technical and operational measures to shape reforms, processes, and financing decisions.Thepathwaysdraw on the literature, case studies, and extensive consultations with government representatives and otherexperts.Rather than a blueprint, they offer a starting point for debate on a fiscal pivot for investing in health. ACKNOWLEDGEMENTS The authors thank the World Bank for publishing this report as a Health, Nutrition and Population (HNP)Discussion Paper—prepared under the overall guidance of the HNP Global Practice Directors Juan Pablo Uribeand Monique Vledder. We are grateful to the peer reviewers who contributedto the development of the report, including OlenaDoroshenko, Tania Dmytraczenko, Srinivas Gurazada, Somil Nagpal, Gaël Raballand, Pia Schneider, and DavidWilson from the World Bank, as well as Nicholas Carroll and Mauricio Soto from the International MonetaryFund. Special thanks also go to Priya Basu, Mickey Chopra, and Ajay Tandon for their written feedback duringthe review process. We appreciate the support of Agnès Couffinhal, Global Team Lead, and other members of the Health FinancingTeam, and we value the contributions from other colleagues in the HNP Global Practice in discussions on thereturns of investing in health for pandemic preparedness and climate change, including Nejma Cheikh, StephenDorey, Magnus Lindelow, Tamer Rabie, and Zara Shubber. Our early thinking drew on many conversations, and we extend our thanks to Firass Abiad, Ricardo Bitran, MarkBlecher, Mukesh Chawla, Tessa Edejer, May Farid, Oyebanji Filani, Ashley Fox, Bob Fryatt, Eduardo GonzálezPier, Andy Haines, Kara Hanson, Michael Reich, and Sandhya Venkateswaran, who generously shared their timeand perspectives. We also benefited from consultations with the Co-Chairs of the Lancet Commission onInvesting in Health—Dean Jamison, Lawrence Summers, and Gavin Yamey. We are gratefulto the experts who helped take stock of the existing evidence through their thorough andcritical literature reviews—Adrian Acero Schravesande, Mariana Barraza, Gordon Betcherman, Ricardo Bitran,Jesse Bump, Matteo Cabello, Mukesh Chawla, Ashley Fox, BobFryatt, Carmen Jacqueline Ho, Krista Kruja,Angèle Mendy, Nadine Montinero, Sandhya Venkateswaran, Kelsey Vaughn, and Sophie Witter—and weappreciate the meticulous work of those who helped assemble and analyze datasets—Aussama Bejroaui,Cameron ScottFiel, Kristin Laub,Qui Lui,and Julio César Ramírez Mieses. Many World Bank colle