The low-and-middle-income-countries (LMICs) of the Global South witness rapid health system development with substantial heterogeneity of affordability of medical care. Financial sustainability challenge is hard to understand without knowledge of economic history. Centuries have witnessed Colonialization, slave trade, world wars, Cold War, Non-Aligned Movement and Colonial Liberation Movements. Painful legacy shaped contemporary economic growth, and ability to invest in healthcare. There is expanding demand for health workforce-to-population ratio and supply of essential pharmaceuticals and medical devices. Despite rapid expansion of the middle class throughout the Global South, out-of-pocket spending remains excessive, while catastrophic healthcare expenditure is widespread. Most of the newly established welfare and abundance of disposable resources for healthcare investment are centered among the BRICS countries (Brazil, Russia, India, China, and South Africa). Despite significant health expenditure growth in PPP terms, LMICs’ insufficiently prioritize medicine in budgetary spending. Global South inability to meet ever-rising demand for medical care will remain constrained by wide socioeconomic inequalities and vulnerability of the poor. Sustained economic growth requires strategic interventions that prioritize equitable healthcare access and financial toxicity protection. Without comprehensive reforms that account for historical legacies and resource constraints, the promise of universal health coverage in the Global South will remain elusive.
Jakovljevic et al. (2026) studied this question.