An Indian perspective on the challenges in global health financing.

In 2012, the Chatham House established a Working Group on Health Financing, of which I was a member, to deliberate on a global framework for health financing (Røttingen et al., 2014) (reference to paper by McIntyre et al., 2017). Intensive discussions and exhaustive studies brought out 20 recommendations. Of them three were important points emphasizing the need for countries to (i) ensure a minimum public spending of USD 86 per capita and at least 5% of the country’s gross domestic product (GDP) for providing universal access to a package of essential health services; (ii) explore the scope available to mobilize domestic resources through better management; and (iii) shift focus in international cooperation toward health system strengthening that enhances equity. Read together these recommendations call on nation states to shift their attention toward enhancing public welfare by prioritizing health in their development agenda and demonstrating a greater political will to dowhatever needs to be done. The articles in this volume provide a detailed exposition of these findings, that if implemented, could lead to a profound reduction in the overall global burden of disease. It is illustrative to evaluate the applicability of these critical recommendations to a country like India that accounts for almost a fifth of the global disease burden. India ranks among 15 countries in the world where public spending on health is about 1% of the GDP. Such a level of spending has been constant in India over the past seven decades, whether its annual GDP growth rate was less than 3% or over 7%. As per the latest estimates, India spends 4.0% of its GDP on health or USD 54 per capita. Of this, only 1.2% of GDP or USD 16% is public spending, while 2.7% of GDP or USD 37 per capita is out-of-pocket expenditure. Such regressive spending patterns help explain India’s inability to contain disease and improve population health. These levels and this pattern of spending also explain why