Research shows that funding for health in developing countries has quadrupled over the past two decades – from $5.6 billion in 1990 to $21.8 billion in 2007. Private donors are gradually displacing governments and agencies like the World Bank and the United Nations as the major channels of global health funding, making up 30% of assistance in 2007. However, health aid does not always reach either the poorest or unhealthiest countries. These are among the conclusions of an Article in this week's edition of The Lancet, written by Dr Nirmala Ravishankar and Professor Christopher Murray, Institute for Health Metrics and Evaluation, University of Washington, Seattle, USA, and colleagues.
The report analyses funding from aid agencies in 22 developed countries, multilateral institutions like the World Health Organization and hundreds of not-for-profit groups and charities. Prior to this report, most private philanthropic donations for health were unaccounted for, meaning that nearly a third of all health aid was not tracked.
Overall, poor countries receive more money than countries with more resources, but there are strong anomalies. Sub-Saharan Africa receives the highest concentration of funding, but some African countries receive less aid than South American countries with lower disease burdens – like Peru and Argentina. Of the 30 low- and middle-income countries with the most illness and premature death, 12 are missing from the list of countries that receive the most health aid, including Angola, Ukraine and Thailand. Mali and Colombia have about the same level of sickness, but Colombia receives three times as much health funding. The study also found that two of the world's emerging economic super powers, China and India receive huge amounts of health aid.
The report shows HIV/AIDS receives at least 23% of funds going into development assistance for health. Tuberculosis and malaria received less than a third of that, even though the combined burden for those diseases is greater than that from HIV/AIDS in developing countries and despite promises by G8 countries that those diseases would receive more funding. At the same time, only 5% channelled to health assistance goes to system-wide health support, such as funding for new clinics, doctor training and prevention programs. Such system-wide support has been identified as a major global health priority.
Other findings of interest include that the scale-up of global health funding doubled from 1990 to 2001 and then doubled again by 2007. Furthermore, growth has been driven largely by donations from the U.S. government and U.S.-based private charitable organizations. In sheer volume, the U.S. accounted for over 50% of total development assistance for health in 2007. But, in terms of the fraction of national income that becomes health aid, the U.S. trails Sweden, Luxembourg, Norway, and Ireland. And finally, The Bill & Melinda Gates Foundation tops the list of private foundations providing global health aid, making up nearly 4% of all health assistance in 2007.
Professor Murray concludes*: "With no one tracking this massive growth in spending, it's no wonder that some countries receive far more than their neighbours for no immediately apparent reason. We're hoping that this attempt to count money that has never been counted before in a careful and consistent way will lead to greater transparency and better use of health resources."
William Heisel, University of Washington Communications T) +1 (206) 897-2886 E) wheisel@u.washington.edu
Jill Oviatt, University of Washington Communications T) +1 206 897-2862 / +1 206 861-6684 E) oviattj@u.washington.edu
For full Article see: http://press.thelancet.com/ghfunding.pdf
Note to editors: *quote direct from Professor Murray and cannot be found in text of Article
A linked Comment will be available later in the week but is not finalised at this time.
Journal
The Lancet