Post on 27-Mar-2015
Tracking Development Assistance for Health
1990 - 2007
Nirmala Ravishankar
October 7, 2009
2
Context for this research It is widely believed that the last decade saw a rapid rise in development
assistance for improving health in low- and middle-income countries.
It is now feared that the funds are shrinking as a result of the global economic downturn.
While there are established methods for accounting for domestic health expenditure, there was no comprehensive system for estimates of the total envelope of global health resources.o OECD’s estimates capture bilateral and multilateral assistance but not
private sourceso Other studies have focused on specific diseases or provided estimates
for select years (Powell-Jackson et al. 2006, Narasimhan & Attaran 2003; Sridhar and Batniji 2008, Michaud 2003)
There is a demand for this information from donors, policy-makers and the academic community
Information on resource inputs is crucial for assessing cost-effectiveness of interventions.
Defining Development Assistance for Health (DAH)
DAH refers to financial and in-kind contributions for improving health and health systems in low- and middle-income countries originating from both public and private sources that flow via institutions whose primary purpose is development assistance.
3
4
The DAH Landscape
Funding Sources
National treasuries
Private individuals
Corporate donations
Channels of Assistance
Bilateral Aid Agencies
UN Agencies
Development Banks
Global Health Initiatives
Private Foundations
International NGOs
Implementing Institutions
Governmental programs
National ministries of health
National Disease control programs
Non-governmental programs National NGOs
Private sector contractors
Universities and research institutions
Defining DAH We focused on the primary channels of
development assistance for health
We focused on direct health (specifically disease-specific support, health system support, and health research funded by the channels) and excluded aid for allied sectors
DAH is comprised of: Disbursements on grants Gross flows for concessionary loans Health-related program expenditures
Only DAH to low and middle income countries is counted
5
Data sources
6
Bilateral agencies in OECD DAC member countries & the European Commission
OECD DAC Aggregate database & the Creditor Reporting System (CRS)
UN Agencies: WHO, UNICEF, UNFPA, and UNAIDS
Financial reports and audited financial statements
The World Bank, ADB, AfDB and IDB
Online project databases and audited financial documents
GAVIGAVI annual reports, country fact sheets, and correspondences
The Global Fund Online grant database
NGOs registered in the USUSAID VolAg reports, tax filings, financial statements & correspondence
The Bill & Melinda Gates Foundation
Online grant database and tax filings
Other private US. FoundationsFoundation Center’s grants database
Key Measurement Challenges The problem of double-counting
Missing disbursement data
Hard to know health fraction of multi-sector grants and loans
International health expenditures by NGOs is not always reported
NGOs and UN agencies do not report country-wise program expenditures
Disease-focus of all grants, loans, and program expenditures is not reported
The role of Global Health Initiatives is growing
All figures show 2007 US dollars
8
US government is the single biggest contributor of global health dollars
9
Where are global health dollars from public sources going?
AUS = Australia, AUT = Austria, BEL = Belgium, CAN = Canada, CHE = Switzerland, DEU = Germany, DNK = Denmark, ESP = Spain, FIN = Finland, FRA = France, GBR = United Kingdom, GRC = Greece, IRL = Ireland, ITA = Italy, JPN = Japan, LUX = Luxembourg, NLD = the Netherlands, NOR =Norway, NZL = New Zealand, PRT = Portugal, SWE =Sweden, USA = United States.
10
For more than 30% of USG funds, information about recipient is not available
Other countries give more as a percent of GDP
AUS = Australia, AUT = Austria, BEL = Belgium, CAN = Canada, CHE = Switzerland, DEU = Germany, DNK = Denmark, ESP = Spain, FIN = Finland, FRA = France, GBR = United Kingdom, GRC = Greece, IRL = Ireland, ITA = Italy, JPN = Japan, LUX = Luxembourg, NLD = the Netherlands, NOR =Norway, NZL = New Zealand, PRT = Portugal, SWE =Sweden, USA = United States.
HIV/AIDs draws considerable funds, but TB and Malaria have grown in recent years….
12
USG and the Global Fund are the biggest contributors of HIV/AIDs funds
13
14
The Global Fund and the Gates Foundation are the biggest contributors of Malaria funds
Sub-Saharan Africa attracts more health aid than other regions of the world
15
Aid is positively correlated with overall disease burden
16
Argentina
Botswana
Belize
Belarus
Brazil
Bulgaria
Chile
Costa Rica
Cuba
Dominica
FijiGabon
Grenada
Croatia
Jamaica Kazakhstan
Lebanon
Latvia
Lithuania
LibyaMauritius
Mexico
Malaysia
Suriname
Poland
Panama
Palau
Russia
St. Kitts & Nevis
Seychelles
South Africa
St. Lucia
Turkey
Uruguay
St. Vincent & the Grenadines
Venezuela
Algeria
Azerbaijan
AlbaniaArmenia
Angola
Bosnia & Herzegovina
Bolivia
Bhutan
Sri Lanka
Congo
China
Cameroon
Colombia
Cape Verde Djibouti
Dominican Republic
Ecuador
Egypt
El Salvador
Micronesia
Georgia
Guatemala
Guyana
Honduras
Indonesia
India
Iran
Iraq
Jordan
Kiribati
LesothoMoldova
MongoliaMacedonia
Morocco
Maldives
Vanuatu
Nicaragua
Paraguay
Peru
Marshall Is.
Philippines
Sudan
Syria
Thailand
Tonga
Tunisia
Timor Leste
Turkmenistan
Ukraine
Namibia
Samoa
Swaziland
Afghanistan
Bangladesh
Myanmar
Benin
Solomon Is.
Burundi
Cambodia
Chad
Congo, DRC
Comoros
Central African Republic
Eritrea
Ethiopia
The Gambia
Ghana
Guinea
Haiti
Cote d'Ivoire
Kenya
Kyrgyzstan
North Korea
Laos
Liberia
Madagascar
Malawi
Mali
Mauritania
Mozambique
Niger
Nigeria
Nepal
Pakistan
Papua New Guinea
Guinea-Bissau
RwandaSenegal
Sierra Leone
SomaliaTajikistan
Togo
Sao Tome & Principe
TanzaniaUganda
Burkina Faso
Uzbekistan
Vietnam
Yemen
Zambia
Zimbabwe
67
89
10
Cum
ula
tive D
AH
(Log 1
0)
4 5 6 7 8 92002 All-Cause DALYs (Log 10)
Upper Middle Income
Lower Middle Income
Low Income
CUMULATIVE DAH FROM 2002-2007 VERSUS ALL-CAUSE DALYs 2002
But other factors are also driving who attracts health assistance
Top 30 country recipients of DAH for health (2002-2007)
vs.
Top 30 countries ranked by
all-cause DALYs in 2002
Key FindingsDevelopment assistance expanded greatly from 1990-2007, particularly post-2002
Private sources are playing an increasingly important role in funding DAH
The increase in DAH was fueled by a huge expansion of dollars for HIV/AIDS, but other areas of global health have also expanded dramatically
New actors in the field of global health such as GAVI, GFATM and NGOs are competing for resources with other channels of assistance like the World Bank and UN agencies
Countries with higher disease burden and poorer countries tend to receive more aid, but burden is not the sole determinant of aid
Better quality data and standardized reporting guidelines are needed
18
Acknowledgements and References
Team: Researchers at the Institute for Health Metrics and Evaluation at the University of Washington, led by Christopher JL Murray
Funding: Core grant from the Bill and Melinda Gates Foundation
Publication: Ravishankar N, Gubbins P, Cooley R, Leach-Kemon K, Michaud M, Jamison D, and Murray CJL, Financing Global Health: Tracking Development Assistance for Health, The Lancet, Vol. 373, No. 9861, June 20, 2009.