Low income countries in Africa and South East Asia see over half of the global disease burden, are home to 40 percent of the global population and account for only 3 percent of health spending. Across low income countries, 30 percent of spending (and over 70 percent in some countries) comes from donors and is often channeled through parallel, inefficient systems that cannot be easily sustained by governments. Donor contributions for health are not increasing at past rates and in many countries are likely to decline. Domestic resources for health are increasing, but the rate of growth is often volatile and insufficient to meet population health needs. In addition, resources that are made available may not be spent efficiently or equitably. As a result providers may be forced to ration services or charge fees. Globally each year an estimated 100 million people are driven below the poverty line due to out of pocket spending and 150 million people face catastrophic health costs, while others avoid seeking care due to user fees.