External funding plays a very different role in national health systems. In the 148 country or area observations dated 2023, seven report that at least half of current health expenditure came from external sources, while 46 report less than 1%. The gap is wide enough that a single global-looking average would hide the most important part of the story: health financing mixes vary sharply from one country to another.
The map uses the World Health Organization indicator External health expenditure (EXT) as percentage of current health expenditure (CHE). It measures the share of current health spending financed from sources outside the country. The latest-value dataset contains 163 country or area observations, but it is not perfectly synchronized: 148 are dated 2023 and 15 use an earlier latest observation from 2008 through 2022. The map therefore shows the latest reported level, while the rankings and distribution analysis below use only the common-year 2023 subset.
Table of Contents
What the indicator measures — and what it does not
WHO defines the indicator as the share of current health expenditure funded from external sources. Its measurement combines transfers of foreign origin that are distributed by government with direct foreign transfers, divided by current health expenditure. The formal definition and formula are available on the WHO indicator metadata page.
A value of 60% means that roughly 60% of the country’s current health expenditure in that observation year was financed from external sources. It does not mean that 60% of the government budget came from foreign aid, that health spending equals 60% of GDP, or that the country received the world’s largest amount of health assistance. This is a financing-share measure, not an absolute-dollar measure.
That distinction matters when comparing large and small health systems. Two countries can both record 20% even if the amount of external money behind that share is very different. To compare absolute resources, a per-capita or total external health expenditure series would be needed instead.
The 2023 distribution is strongly skewed
Among the 148 observations dated 2023, the unweighted median is about 6.0% and the simple mean is about 13.0%. The mean is much higher because a relatively small group of countries sits in the 40–70% range. These are descriptive country-level statistics: each observation gets the same weight, so they are not a population-weighted or expenditure-weighted world share.
Forty-six observations are below 1%, and another 25 fall from 1% to under 5%. Together, 71 of 148 are below 5%. At the upper end, 22 are at 30% or more and seven are at 50% or more. Looking at the full set of bands makes the long upper tail much clearer than quoting the mean alone.
Micronesia, Malawi and South Sudan lead the synchronized 2023 ranking
The Federated States of Micronesia has the highest 2023 observation at about 71.5%. Malawi follows at 65.5% and South Sudan at 62.3%. Mozambique, Burundi, Somalia and Niue are also above 50%. Zambia, Zimbabwe, Tonga, Uganda and Sao Tome and Principe sit just below that threshold but remain among the highest reported shares.
| Country or area | External share of CHE, 2023 |
|---|---|
| Micronesia (Federated States of) | 71.5% |
| Malawi | 65.5% |
| South Sudan | 62.3% |
| Mozambique | 57.7% |
| Burundi | 57.4% |
| Somalia | 54.4% |
| Niue | 54.4% |
| Zambia | 47.9% |
| Zimbabwe | 45.0% |
| Tonga | 44.2% |
| Uganda | 44.1% |
| Sao Tome and Principe | 43.9% |
This is a ranking of shares, not a ranking of the amount of money received. A smaller health system can appear near the top if external transfers finance a large fraction of its current spending. Conversely, a country can receive a sizeable amount of external health funding and still have a low share if total domestic health spending is much larger.
A high-share cluster appears across parts of eastern and southern Africa
The clearest large-area pattern on the map is the concentration of higher values across parts of Sub-Saharan Africa. Malawi is at 65.5%, Mozambique 57.7%, Zambia 47.9%, Zimbabwe 45.0% and Tanzania 39.4%. Farther north and east, Burundi records 57.4%, Uganda 44.1%, Rwanda 37.0% and the Democratic Republic of the Congo about 37.0%.
The region is not uniform. Kenya is around 20.1%, Ethiopia 26.9% and Nigeria 12.2%, well below several nearby high-share countries. The map therefore supports a geographic description of where external financing is more prominent, but it does not support a single “Africa rate” or a causal claim about why each country is high or low.
Pacific island observations also stand out. The Federated States of Micronesia is at 71.5%, Niue 54.4%, Tonga 44.2% and Solomon Islands 33.9%. Some of these places are too small to have a clearly visible polygon in a low-resolution world map, so the table and statistical calculations are important complements to the visual.
Very low external shares occur in several different regions
At the other end of the 2023 distribution, 46 observations are below 1%. Serbia, Malaysia, China, the United Kingdom, Estonia, the Netherlands, Belgium, Colombia and Brazil are among the countries with extremely small external shares in this dataset. Several values are below 0.01%, so rounding them to two decimal places can visually resemble zero even though the original values are positive.
A low external share does not identify the rest of the financing mix. The remaining current health expenditure may come from government budgets, compulsory or voluntary insurance, household out-of-pocket payments, other domestic private sources, or combinations of these. This indicator only isolates the externally financed component.
Why the latest-value map is not a pure 2023 comparison
Fifteen of the 163 latest observations predate 2023. Russia’s latest value in this file is from 2008 and Norway’s from 2010. Saint Kitts and Nevis is dated 2013, Chile 2015 and North Macedonia 2018. Malta, Peru and Ukraine use 2019; Finland and Seychelles use 2020; Mexico, Romania and Uruguay use 2021; Iraq and Antigua and Barbuda use 2022.
Those observations are useful for showing the latest value available for each country, but they should not be treated as if they were measured in the same year. The map marks older observations with hatched outlines. All of the 2023 band counts, mean, median and ranked table exclude those 15 older rows rather than relabeling them as current.
This difference between a latest-value map and a synchronized-year ranking is especially important when values change over time. A country shown at 2% from 2010 should not be placed next to a 2023 country in a fine-grained ranking without first acknowledging the 13-year gap.
A high share is not a verdict on health-system performance
A large external share tells us that funding from outside the country played a large role in financing current health services in that observation year. It does not tell us whether the money was spent efficiently, whether health outcomes improved, whether patients had good access to care, or whether the funding source is stable over time.
The reverse is also true. A near-zero external share does not prove that a health system is adequately financed. Total spending per person could still be low, or households could finance a large share through out-of-pocket payments. Questions about adequacy, equity and financial protection require additional indicators such as current health expenditure per capita, domestic government health expenditure, out-of-pocket spending and service coverage.
The map also cannot explain causes. Income, conflict, donor programs, disease burdens, fiscal capacity and policy choices may all be relevant in country-specific research, but none of those variables is present in this single financing-share series. The safest use is descriptive: identify where external financing is a large or small component, then bring in other evidence for explanation.
Data source and mapping method
The statistical source is WHO Global Health Observatory indicator GHED_EXTCHE_SHA2011. WHO reports the unit as percent and defines it as the share of current health expenditure funded from external sources. The indicator definition is available from WHO Global Health Observatory, and the broader health accounts database can be accessed through the WHO Global Health Expenditure Database.
The latest-value map uses all 163 retained country or area observations. Of these, 148 are dated 2023 and 15 are older latest values. The synchronized distribution, summary statistics and ranking table use only the 148 rows dated 2023. Missing values are not converted to zero, and an older observation is never relabeled as 2023.
ISO-3 country codes are joined to a simplified world boundary layer for the map. Some small island states and separately reported areas may not appear as a distinct polygon at this global scale even though their values remain in the statistical sample. The color bands are intended to show large differences in financing structure rather than tiny decimal-point ranking differences.
Frequently Asked Questions
What does external health expenditure as a share of current health expenditure mean?
It is the percentage of current health expenditure financed from external sources, including foreign-origin transfers distributed by government and direct foreign transfers.
Which country or area has the highest 2023 external health expenditure share?
Among the 148 observations dated 2023, the Federated States of Micronesia is highest at about 71.5%, followed by Malawi at 65.5% and South Sudan at 62.3%.
Are all values on the map from 2023?
No. Of the 163 latest observations, 148 are from 2023 and 15 are the latest available values from 2008–2022. The 2023 ranking and distribution use only the synchronized 148-row subset.
Does a high external share mean a health system performs poorly?
No. The indicator describes the financing mix, not health-system performance, service access, spending adequacy, efficiency or health outcomes.
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- Rural Cooking Energy Gap in 2023 – Global Map
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