The poorest are most in need, yet suffer the greatest

Although a number of low-income countries such as Rwanda have taken decisive steps towards the extension of health protection, these countries generally face more significant funding constraints in extending health protection than middle- and high-income countries. The reasons often relate to higher levels of poverty, and thus lower income from taxes, combined with higher needs for subsidies. The situation if often worsened by weak institutional capacities to collect taxes and provide services. The resulting lack of financial resources often leads to high barriers in access to needed quality care, affecting particularly vulnerable population groups such as the poor and those living in rural areas.

Currently ILO estimates that US$ 239 per capita (except out-of-pocket payments) are needed to provide universal access to essential health services. This relative threshold derives from related expenditure in low vulnerable countries that share enabling socio-economic characteristics and fair health financing mechanisms. It represents the population-weighted median value of per capita expenditure in these countries. It is regularly updated and thus reflects current trends and developments.

The financial deficit (FD) indicator allows assessing the financial resource deficit that hinders the population to access needed care. It is calculated as the relative difference of per capita expenditure in a given country and the threshold of US$ 239. Currently, 92.6 per cent of the population in low income countries has no access to health care due to the existing funding gaps. In lower-middle income countries 84 per cent of the population is excluded from access to health care due to the financial resource gap; it amounts to 18.1 per cent in upper middle income countries. Globally, 47.4 per cent of the population cannot access needed care due to this deficit.

Financial resource deficit by level of country income