Despite notable scientific and medical advances, broader political, socioeconomic and behavioural factors continue to undercut the response to the COVID-19 pandemic1,2. Here we convened, as part of this Delphi study, a diverse, multidisciplinary panel of 386 academic, health, non-governmental organization, government and other experts in COVID-19 response from 112 countries and territories to recommend specific actions to end this persistent global threat to public health. The panel developed a set of 41 consensus statements and 57 recommendations to governments, health systems, industry and other key stakeholders across six domains: communication; health systems; vaccination; prevention; treatment and care; and inequities. In the wake of nearly three years of fragmented global and national responses, it is instructive to note that three of the highest-ranked recommendations call for the adoption of whole-of-society and whole-of-government approaches1, while maintaining proven prevention measures using a vaccines-plus approach2 that employs a range of public health and financial support measures to complement vaccination. Other recommendations with at least 99% combined agreement advise governments and other stakeholders to improve communication, rebuild public trust and engage communities3 in the management of pandemic responses. The findings of the study, which have been further endorsed by 184 organizations globally, include points of unanimous agreement, as well as six recommendations with >5% disagreement, that provide health and social policy actions to address inadequacies in the pandemic response and help to bring this public health threat to an end.

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This report traces the progressive expansion of health accounts (HA) to measure national health expenditures, from the first attempts in 1926 by the American Medical Association to the present day. Milestones in the development of A System of Health Accounts (SHA) are covered, from the economic background to initial efforts by a few countries and organizations, to the need for a set of accounting standards for health care systems, and finally, to consolidation with SHA 2011. International organizations, such as the World Health Organization, Organization for Economic Cooperation and Development, Eurostat, the World Bank, and the United States Agency for International Development have been critical to expanding national HA exercises and ensuring that these are standardized, comparable, and become institutionalized. National efforts to track health expenditures have not only enriched collective results, but have become an important component of global leadership, informing policy the world over. More than 100 countries have created HA under the global standard and have gained a better understanding of health spending and financial flows. These results are key for monitoring progress toward national and global initiatives, such as the Sustainable Development Goals and Universal Health Coverage. Challenges remain to be tackled, among them institutionalization and quality of results. Social responsibility for improving data sources and expanding the generation and usability of health accounts are also needed.

Este informe describe el proceso de ampliación progresiva de las cuentas de salud para medir los gastos nacionales en salud, desde los primeros intentos de la Asociación Médica Estadounidense en 1926 hasta la actualidad. Se mencionan los hitos en la creación del Sistema de Cuentas de Salud , desde los antecedentes económicos y las acciones iniciales de unos cuantos países y organizaciones a la necesidad de un conjunto de normas de contabilidad para los sistemas de atención de salud y, por último, la consolidación con el Sistema de Cuentas de Salud del 2011. Varias organizaciones internacionales, como la Organización Mundial de la Salud, la Organización para la Cooperación y el Desarrollo Económicos, Eurostat, el Banco Mundial y la Agencia de los Estados Unidos para el Desarrollo Internacional, han sido fundamentales para ampliar los ejercicios nacionales de cuentas de salud y asegurar que estén normalizados, sean comparables y se institucionalicen. Las acciones nacionales para realizar un seguimiento de los gastos en salud no solo han enriquecido los resultados colectivos, sino que se han convertido en un componente importante del liderazgo mundial, al fundamentar las políticas en todo el mundo. Más de 100 países han creado cuentas de salud de conformidad con la norma mundial, y han logrado una mejor comprensión del gasto en salud y de los flujos financieros. Estos resultados son clave para vigilar los avances relativos a las iniciativas nacionales y mundiales, como los Objetivos de Desarrollo Sostenible y la cobertura universal de salud. Todavía quedan retos por delante, como la institucionalización y la calidad de los resultados. También se necesita responsabilidad social para mejorar las fuentes de datos, y aumentar la producción y eluso de las cuentas de salud.

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