Imagine two countries with the same population, but very different levels of government revenue. In one, hospitals are staffed and well equipped, patients are admitted quickly, and mothers give birth safely. In the other, shortages of nurses and beds leave patients waiting or untreated. This difference hinges on each government’s fiscal capacity, or how much the government can afford to spend, and how effectively it spends it.
This is exactly what the Government Revenue and Development Estimations (GRADE) model helps to explore. Developed at the Universities of St Andrews and Leicester, GRADE shows how changes in government revenue affect progress toward Sustainable Development Goals (SDGs) such as education, sanitation, and health. The logic behind GRADE is simple. When governments raise more domestic revenue, they can invest more in essential public services. Research underpinning the model shows that higher government revenue per capita is strongly linked to improvements in key health and social indicators from child survival to school attendance.
And now, the model has been expanded to include two powerful new indicators to provide users an even clearer picture of how government revenue translates into real-world health capacity, the kind that saves lives.
Hospital beds reflect the capacity of the health system to provide inpatient care, respond to emergencies, and handle outbreaks. On the other hand, nurses are the backbone of healthcare, often forming the first and most frequent point of contact for patients.
Why Revenue Matters
Low-income countries lose billions of financial outflows annually. For instance, interest payments on external debt now consume more than 10 percent of government revenue in 56 countries. When countries lose revenue, they also lose capacity, not just in abstract economic terms but in the number of trained nurses, hospital capacity, and ultimately, lives saved.
How the GRADE Tool Helps
The free online GRADE model allows users to explore how small changes in revenue might impact socioeconomic development outcomes.
For example, users can, select a country, say Tanzania and input an increase (or decrease) in government revenue per capita and instantly see how this affects access to hospital beds, nurses, and other sustainable development goal-linked indicators over time.
Figure 1: According to Debt Justice data, in 2024, Tanzania spent 19.4% of its government revenue servicing external debt. If the government of Tanzania had this additional revenue there would have been about 4000 additional nursing posts and hospital beds with an estimated 400 maternal deaths prevented every year.
Linking Back to the Sustainable Development Goals – the addition of hospital beds and nurses connects directly to SDG 3: Good Health and Well-being, particularly targets 3.8 (achieving universal health coverage) and 3.c (substantially increasing health financing and the health workforce).
Further, the impact on health acts via many other routes, for example, there would also be improved governance, improved access to clean water, sanitation, education, electricity and clean fuels all contribute to improved health.
What This Means for Policymakers and Advocates
By quantifying the connection between government revenue, governance, and health capacity, the updated GRADE model provides actionable evidence for the following; Health ministries, to argue for fairer and more sustainable financing, Finance ministries to understand the developmental impact of tax policies, Civil societies and journalists hold governments and global lenders accountable for revenue decisions.
Explore
- To use the GRADE model, see the videos and the user guide.
- Connect: Follow GRADE on LinkedIn
