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Even in this simplified representation, we can see that there are a great many components to global financing at present . To understand it we need to go well beyond an understanding of the main multilateral mechanisms. The largest contribution is from governments in high-income countries . These go through both bilateral and multilateral channels. The next most important contribution is from governments in the affected low and middle-income countries . This source is often underestimated. We still do not know to any accuracy how much is paid out of pocket by affected individuals in low and middle-income countries. The amount may well be larger than what is represented here.