Tracking development assistance for health and for COVID-19 : a review of development assistance, government, out-of-pocket, and other private spending on health for 204 countries and territories, 1990-2050

Background The rapid spread of COVID-19 renewed the focus on how health systems across the globe are financed, especially during public health emergencies. Development assistance is an important source of health financing in many low-income countries, yet little is known about how much of this funding was disbursed for COVID-19. We aimed to put development assistance for health for COVID-19 in the context of broader trends in global health financing, and to estimate total health spending from 1995 to 2050 and development assistance for COVID-19 in 2020. Methods We estimated domestic health spending and development assistance for health to generate total health-sector spending estimates for 204 countries and territories. We leveraged data from the WHO Global Health Expenditure Database to produce estimates of domestic health spending. To generate estimates for development assistance for health, we relied on project-level disbursement data from the major international development agencies' online databases and annual financial statements and reports for information on income sources. To adjust our estimates for 2020 to include disbursements related to COVID-19, we extracted project data on commitments and disbursements from a broader set of databases (because not all of the data sources used to estimate the historical series extend to 2020), including the UN Office of Humanitarian Assistance Financial Tracking Service and the International Aid Transparency Initiative. We reported all the historic and future spending estimates in inflation-adjusted 2020 US$, 2020 US$ per capita, purchasing-power parity-adjusted US$per capita, and as a proportion of gross domestic product. We used various models to generate future health spending to 2050. Findings In 2019, health spending globally reached$8. 8 trillion (95% uncertainty interval [UI] 8.7-8.8) or $1132 (1119-1143) per person. Spending on health varied within and across income groups and geographical regions. Of this total,$40.4 billion (0.5%, 95% UI 0.5-0.5) was development assistance for health provided to low-income and middle-income countries, which made up 24.6% (UI 24.0-25.1) of total spending in low-income countries. We estimate that $54.8 billion in development assistance for health was disbursed in 2020. Of this,$13.7 billion was targeted toward the COVID-19 health response. $12.3 billion was newly committed and$1.4 billion was repurposed from existing health projects. $3.1 billion (22.4$2.4 billion (17.9%) was for supply chain and logistics. Only $714.4 million (7.7$1519 (1448-1591) per person in 2050, although spending across countries is expected to remain varied. Interpretation Global health spending is expected to continue to grow, but remain unequally distributed between countries. We estimate that development organisations substantially increased the amount of development assistance for health provided in 2020. Continued efforts are needed to raise sufficient resources to mitigate the pandemic for the most vulnerable, and to help curtail the pandemic for all. Copyright (C) 2021 The Author(s). Published by Elsevier Ltd.Peer reviewe

Global, regional, and national age-sex-specific mortality and life expectancy, 1950–2017: a systematic analysis for the Global Burden of Disease Study 2017

BACKGROUND: Assessments of age-specific mortality and life expectancy have been done by the UN Population Division, Department of Economics and Social Affairs (UNPOP), the United States Census Bureau, WHO, and as part of previous iterations of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD). Previous iterations of the GBD used population estimates from UNPOP, which were not derived in a way that was internally consistent with the estimates of the numbers of deaths in the GBD. The present iteration of the GBD, GBD 2017, improves on previous assessments and provides timely estimates of the mortality experience of populations globally. METHODS: The GBD uses all available data to produce estimates of mortality rates between 1950 and 2017 for 23 age groups, both sexes, and 918 locations, including 195 countries and territories and subnational locations for 16 countries. Data used include vital registration systems, sample registration systems, household surveys (complete birth histories, summary birth histories, sibling histories), censuses (summary birth histories, household deaths), and Demographic Surveillance Sites. In total, this analysis used 8259 data sources. Estimates of the probability of death between birth and the age of 5 years and between ages 15 and 60 years are generated and then input into a model life table system to produce complete life tables for all locations and years. Fatal discontinuities and mortality due to HIV/AIDS are analysed separately and then incorporated into the estimation. We analyse the relationship between age-specific mortality and development status using the Socio-demographic Index, a composite measure based on fertility under the age of 25 years, education, and income. There are four main methodological improvements in GBD 2017 compared with GBD 2016: 622 additional data sources have been incorporated; new estimates of population, generated by the GBD study, are used; statistical methods used in different components of the analysis have been further standardised and improved; and the analysis has been extended backwards in time by two decades to start in 1950. FINDINGS: Globally, 18·7% (95% uncertainty interval 18·4–19·0) of deaths were registered in 1950 and that proportion has been steadily increasing since, with 58·8% (58·2–59·3) of all deaths being registered in 2015. At the global level, between 1950 and 2017, life expectancy increased from 48·1 years (46·5–49·6) to 70·5 years (70·1–70·8) for men and from 52·9 years (51·7–54·0) to 75·6 years (75·3–75·9) for women. Despite this overall progress, there remains substantial variation in life expectancy at birth in 2017, which ranges from 49·1 years (46·5–51·7) for men in the Central African Republic to 87·6 years (86·9–88·1) among women in Singapore. The greatest progress across age groups was for children younger than 5 years; under-5 mortality dropped from 216·0 deaths (196·3–238·1) per 1000 livebirths in 1950 to 38·9 deaths (35·6–42·83) per 1000 livebirths in 2017, with huge reductions across countries. Nevertheless, there were still 5·4 million (5·2–5·6) deaths among children younger than 5 years in the world in 2017. Progress has been less pronounced and more variable for adults, especially for adult males, who had stagnant or increasing mortality rates in several countries. The gap between male and female life expectancy between 1950 and 2017, while relatively stable at the global level, shows distinctive patterns across super-regions and has consistently been the largest in central Europe, eastern Europe, and central Asia, and smallest in south Asia. Performance was also variable across countries and time in observed mortality rates compared with those expected on the basis of development. INTERPRETATION: This analysis of age-sex-specific mortality shows that there are remarkably complex patterns in population mortality across countries. The findings of this study highlight global successes, such as the large decline in under-5 mortality, which reflects significant local, national, and global commitment and investment over several decades. However, they also bring attention to mortality patterns that are a cause for concern, particularly among adult men and, to a lesser extent, women, whose mortality rates have stagnated in many countries over the time period of this study, and in some cases are increasing

Influência da densidade de plantio e da cama de frango na produção da carobinha (Jacaranda decurrens Cham. ssp. symmetrifoliolata Farias & Proença)

Carobinha (Jacaranda decurrens Cham. ssp. symmetrifoliolata Farias & Proença) é uma planta medicinal que ocorre no Cerrado de Mato Grosso do Sul. A espécie vem sendo amplamente utilizada pela medicina popular como depurativa do sangue e cicatrizante de feridas uterinas e dos ovários, resultando na sua exploração predatória. Por ser uma espécie identificada recentemente, os estudos sobre adaptação ex situ são ainda escassos. O objetivo deste trabalho foi avaliar o crescimento, o desenvolvimento, e a produção da carobinha cultivada ex situ em cinco espaçamentos entre plantas dentro das fileiras, em parcelas adubadas com e sem cama semidecomposta de frango de corte. O experimento foi desenvolvido no Horto de Plantas Medicinais (HPM) da Universidade Federal da Grande Dourados - UFGD, em Dourados-MS, de abril de 2006 a outubro de 2007. Os espaçamentos entre plantas foram: 0,30; 0,35; 0,40; 0,45 e 0,50 m, sendo a cama de frango aplicada na dose de 10 t ha-1 nas parcelas com este tratamento. O ensaio fatorial 5x2, foi conduzido no delineamento experimental de blocos casualizados, sendo a parcela constituída de 4,5 m², com quatro repetições. As mudas foram obtidas a partir de sementes coletadas de uma população de 40 plantas nativas, distribuídas ao acaso, em área de cerca de 100 m² com vegetação característica de Cerrado. Durante o cultivo avaliou-se a altura das plantas a cada 30 dias a partir de 150 até 480 dias após o transplante (DAT). As plantas foram colhidas aos 480 DAT, quando avaliou-se as massas fresca e seca da parte aérea, raízes, área foliar, e o comprimento e o diâmetro da maior raiz. A altura máxima (1,58 m) foi alcançada aos 471 DAT no espaçamento de 0,50 m entre plantas, tratadas com a cama de frango. Os dados de produtividade foram influenciados significativamente pelos espaçamentos, mas não pela adição da cama. O rendimento de massa seca das folhas por hectare não foi influenciado pelo espaçamento. A máxima área foliar foi obtida no espaçamento 0,50 m. Os maiores valores de massa seca de caules por hectare ocorreram no espaçamento de 0,30 m. Os maiores diâmetros de raiz, de xilopódio, e de caule, ocorreram no espaçamento 0,30 m, sendo os máximos valores de comprimento de raiz e de xilopódio também observados neste espaçamento. Os maiores rendimentos de massa seca de raiz (4,564 t ha-1) e de xilopódio (2,102 t ha-1) foram obtidos no espaçamento 0,30 m. Pelos resultados obtidos, concluiu-se que para se obter maiores produções de carobinha ela deve ser cultivada no espaçamento de 0,30 m, independente da cama de frango

Efeito de composto orgânico sobre a produção e características comerciais de alface americana Effect of organic compost on crisp head lettuce production and commercial characteristics

Doses de composto orgânico foram avaliadas na produtividade e qualidade da alface americana em um ensaio em Três Pontas, de 08/07 a 30/08/02. O delineamento utilizado foi em blocos casualizados com quatro repetições, sendo os tratamentos constituídos por cinco doses de composto orgânico (0,0; 20,0; 40,0; 60,0 e 80,0 t ha-1). A massa fresca total evidenciou um efeito quadrático, na qual a produtividade máxima de 914,2 g planta-1, foi obtida com a dose de 59,4 t ha-1 do composto orgânico. Para massa fresca comercial, a máxima produtividade (634,3 g planta-1), foi obtida com a dose de 56,1 t ha-1. A maior circunferência da cabeça comercial (41,4 cm), foi obtida com a dose de 53,7 t ha-1. A dose de 42,7 t ha-1 proporcionou um comprimento de caule máximo de 3,9 cm. Diante desses resultados, pode-se concluir que o uso de 56,0 t ha-1 de composto orgânico aplicado em pré-plantio, proporciona aumento de rendimento e qualidade comercial da alface americana.<br>Doses of organic compost were evaluated on crisp head lettuce production and quality in an experiment conduced in Três Pontas, Brazil, from July 8>th to August 30th. The experimental design was in randomized complete blocks with four replicates, the treatments being constituted by five doses of organic compost (0.0; 20.0; 40.0; 60.0 and 80.0 t ha-1). Total fresh matter showed a quadratic effect, in which the maximum yield of 914.2 g plant-1 was obtained with the dose of 59.4 t ha-1 of organic compost. For commercial fresh matter, the maximum yield (634.3 g plant-1) was obtained with the dose of 56.1 t ha-1. The greatest commercial head circumference (41.4 cm) was obtained with the dose of 53.7 t ha-1. The dose of 42.7 t ha-1 caused a maximum stem length of 3.9 cm. These results permit to conclude that the use of 56.0 t ha-1 of organic compost applied in pre plant provides an increase in yield and commercial quality of crisp head lettuce