Global overview of health systems oversight and financing for kidney care

Aminu K. Bello, Mona Alrukhaimi, Gloria E. Ashuntantang, Ezequiel Bellorin-Font, Mohammed Benghanem Gharbi, Branko Braam, John Feehally, David C. Harris, Vivekanand Jha, Kailash Jindal, David W. Johnson, Kamyar Kalantar-Zadeh, Rumeyza Kazancioglu, Peter G. Kerr, Meaghan Lunney, Timothy Olusegun Olanrewaju, Mohamed A. Osman, Jeffrey Perl, Harun Ur Rashid, Ahmed RatebEric Rondeau, Aminu Muhammad Sakajiki, Arian Samimi, Laura Sola, Irma Tchokhonelidze, Natasha Wiebe, Chih Wei Yang, Feng Ye, Alexander Zemchenkov, Ming hui Zhao, Adeera Levin

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Reliable governance and health financing are critical to the abilities of health systems in different countries to sustainably meet the health needs of their peoples, including those with kidney disease. A comprehensive understanding of existing systems and infrastructure is therefore necessary to globally identify gaps in kidney care and prioritize areas for improvement. This multinational, cross-sectional survey, conducted by the ISN as part of the Global Kidney Health Atlas, examined the oversight, financing, and perceived quality of infrastructure for kidney care across the world. Overall, 125 countries, comprising 93% of the world's population, responded to the entire survey, with 122 countries responding to questions pertaining to this domain. National oversight of kidney care was most common in high-income countries while individual hospital oversight was most common in low-income countries. Parts of Africa and the Middle East appeared to have no organized oversight system. The proportion of countries in which health care system coverage for people with kidney disease was publicly funded and free varied for AKI (56%), nondialysis chronic kidney disease (40%), dialysis (63%), and kidney transplantation (57%), but was much less common in lower income countries, particularly Africa and Southeast Asia, which relied more heavily on private funding with out-of-pocket expenses for patients. Early detection and management of kidney disease were least likely to be covered by funding models. The perceived quality of health infrastructure supporting AKI and chronic kidney disease care was rated poor to extremely poor in none of the high-income countries but was rated poor to extremely poor in over 40% of low-income countries, particularly Africa. This study demonstrated significant gaps in oversight, funding, and infrastructure supporting health services caring for patients with kidney disease, especially in low- and middle-income countries.

Original languageEnglish
Pages (from-to)41-51
Number of pages11
JournalKidney International Supplements
Issue number2
Publication statusPublished - 1 Feb 2018


  • delivery of health care
  • developing countries
  • global health care
  • global health governance
  • health care financing
  • nephrology

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