Until the COVID pandemic, public spending in low- and low-middle-income countries had been growing modestly. As a result, governments expanded service provision, including in social sectors, and enlarged welfare programs. This was made possible in part by domestic revenue growth. However, the pandemic has significantly lowered revenue receipts of these countries, while creating pressures to spend more on shielding the population and providing support to the economy. Unfortunately, health outlays did not increase as a share of total output during 2000–2018. The preliminary evidence compiled in this paper shows that health spending in relation to GDP increased virtually in all low and low-middle income countries in 2020, though not by as much as in advanced economies. However, higher health spending in low and low-middle income countries is unlikely to be sustained because of the pandemic’s adverse impact on revenues and other spending pressures.

Furthermore, COVID has critically scarred the future productivity of these countries.

Before the pandemic, the achievement of the Sustainable Development Goals (SDGs) by 2030 was doubtful in part because of the slow pace in generating additional revenues from domestic sources. As the financing needs have increased, the achievement of these goals will be delayed beyond 2030, unless additional financing sources can be found.

This means that policy actions will need to be taken by these countries to create additional fiscal space going forward. There is potential to raise more revenues from domestic sources by implementing politically difficult policy measures and generating savings by improving the quality of public spending, including on health.