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30 THIRD WHO REPORT ON NEGLECTED TROPICAL DISEASES
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Fig. 2.7 Targets for domestic investment in universal coverage against NTDs, by country income group
Low-income Middle-income (lower-middle) Middle-income (upper-middle)
Constant US$ millions
1500
1000
500
Excluding vector control
0
2015
2020
2025
2030
2015
2020
Year
2025
2030
2015
2020
2025
2030
Notes: This is the domestic investment target combining both prevention (Fig. 2.5) and treatment and care (Fig. 2.6) or all panels of Fig. 2.4. Shaded areas reflect the range determined by low and high
values of the unit cost benchmarks; they do not reflect uncertainty about future rates of scale-up and scale-down of interventions. All numbers expressed in US$ are constant (real) US$, adjusted to
reflect purchasing power in the United States of America in 2015.
Fig. 2.8 illustrates the differences between countries in the relative scale of domestic
investments being targeted. The domestic investment target is expressed in per capita terms
– that is, a country’s target is divided by its total population. Excluding vector control,
domestic investment targets are everywhere less than US$ 1.33 per capita in 2015 and
everywhere less than US$ 0.35 by 2030. Over the period 2015–2030, the average is US$ 0.10
per capita for the group of low-income countries, US$ 0.11 for lower-middle-income
countries and US$ 0.02 for upper-middle-income countries. Targets for vector control are
not depicted. Including vector control, domestic investment targets are markedly higher,
but remain below US$ 16.50 per capita in 2015 and below US$ 3.25 by 2030. During the
period 2015–2030, the average is US$ 0.22 per capita for the group of low-income countries,
US$ 0.28 for lower-middle-income countries and US$ 0.33 for upper-middle-income
countries.
These targets are low relative to what is already being spent on health from domestic
sources, both public and private. In 2011, per capita domestic expenditure on health was
US$ 21 in low-income countries, US$ 80 in lower-middle-income countries and US$ 406 in
upper-middle-income countries (24). The High Level Taskforce on Innovative International
Financing for Health Systems estimated that ensuring coverage with a set of essential health
services would require US$ 60 per person in low-income countries in 2015.
In theory, domestic investment can be public or private. In practice, however, prevention
will likely have to be financed by government, and treatment and care, if not financed by
government, will require subsidies for compulsory prepayment into pooled funds such as a
health insurance. Government and pooled financing of NTDs is most likely to occur within
the context of UHC reform.