council on foreign relations new york financing global health_murray_113010_ihme

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council on foreign relations new york financing global health_murray_113010_ihme

  1. 1. Financing Global Health 2010: November 30, 2010 Christopher Murray Director <ul><li>Development assistance and country spending in </li></ul><ul><li>economic uncertainty </li></ul>
  2. 2. Outline <ul><li>Why Track Development Assistance for Health? </li></ul><ul><li>Financing Global Health 2010 Methods </li></ul><ul><li>Key Findings on DAH </li></ul><ul><li>Recipient Government Responses </li></ul><ul><li>What is Coming in 2011? </li></ul>
  3. 3. IHME’s work focuses on three questions <ul><li>What are people’s health problems? – e.g., tracking adult, child, or maternal mortality; the Global Burden of Disease 2010 </li></ul><ul><li>How well is society doing in addressing these health problems? – e.g., inputs, outputs, and outcomes from public health, medical care, and other key social determinants </li></ul><ul><li>What can be done in the future to maximize health improvement? – e.g., cost-effectiveness of major intervention and health system intervention options </li></ul>
  4. 4. Tracking health financing <ul><li>Financing Global Health 2009 tracked Development Assistance for Health (DAH) – flows from key development-focused organizations for the advancement of global health. </li></ul><ul><li>Financing Global Health 2010 tracks DAH and government health expenditures. </li></ul><ul><li>Working on a systematic analysis of all available sources of data on out-of-pocket household expenditures on health for 1990-2010. </li></ul><ul><li>Future editions of FGH will include all three components: DAH, government, and private expenditures on health. </li></ul>
  5. 5. Outline <ul><li>Why Track Development Assistance for Health? </li></ul><ul><li>Financing Global Health 2010 Methods </li></ul><ul><li>Key Findings on DAH </li></ul><ul><li>Recipient Government Responses </li></ul><ul><li>What is Coming in 2011? </li></ul>
  6. 6. Channels of development assistance for health
  7. 7. NGO revision for in-kind revenue <ul><li>US NGOs claim drug and equipment donations at US wholesale prices, while the donors claim at production costs. </li></ul><ul><li>On average, international prices are only one-quarter to one-fifth of US wholesale prices. </li></ul><ul><li>We have estimated empirically this relationship and deflated all donations to all NGOs by the same average factor. NGO-specific deflators have not been possible to develop. </li></ul>
  8. 8. Preliminary estimates for donors and agencies <ul><li>Financing Global Health 2009 and The Lancet results on financing global health through 2007 reflect the lag in audited financial statements. </li></ul><ul><li>Using audited financial statements and tax returns, we have data for 2008. </li></ul><ul><li>We have developed preliminary estimates for 2009 and 2010 by analyzing the historical relationship between budgets for donors and agencies and disbursements. </li></ul><ul><li>Preliminary estimates for non-US government NGO revenue are the most uncertain. </li></ul>
  9. 9. Outline <ul><li>Why Track Development Assistance for Health? </li></ul><ul><li>Financing Global Health 2010 Methods </li></ul><ul><li>Key Findings on DAH </li></ul><ul><li>Recipient Government Responses </li></ul><ul><li>What is Coming in 2011? </li></ul>
  10. 10. DAH by channel of assistance, 1990-2010
  11. 11. Total overseas health expenditures channeled through US NGOs by funding source, 1990-2010
  12. 12. Fund balances for UN health-related agencies at the end of 2009
  13. 13. DAH as a percentage of national income, 2008
  14. 14. Public sector DAH by donor country received by channels of assistance, 2008
  15. 15. Total DAH per-all cause DALY, 2003-2008
  16. 16. Top 30 country recipients of DAH versus top 30 countries ranked by all-cause burden of disease
  17. 17. DAH by health focus area Scale-up most dramatic for HIV/AIDS, malaria, and tuberculosis. Maternal, newborn, and child health aid slower but increasing. NCDs less than $120 million per year in 2008.
  18. 18. Outline <ul><li>Why Track Development Assistance for Health? </li></ul><ul><li>Financing Global Health 2010 Methods </li></ul><ul><li>Key Findings on DAH </li></ul><ul><li>Recipient Government Responses </li></ul><ul><li>What is Coming in 2011? </li></ul>
  19. 19. Domestic financing of health by governments has been increasing
  20. 20. What happens to domestic finance in countries that receive large amounts of DAH? <ul><li>Our analysis of how Ministries of Finance respond when governments receive DAH was published April 2010 in The Lancet. </li></ul><ul><li>Responses vary substantially, but on average, finance ministries decrease health expenditures from their own sources by a range of 43 cents to $1.14 for every dollar of DAH received by governments. </li></ul><ul><li>Debate is not about whether this occurs but whether it is welfare-enhancing. </li></ul><ul><li>Perspectives vary widely between macro-economists and health specialists and between donors, Ministries of Health, and Ministries of Finance. </li></ul>
  21. 21. Outline <ul><li>Why Track Development Assistance for Health? </li></ul><ul><li>Financing Global Health 2010 Methods </li></ul><ul><li>Key Findings on DAH </li></ul><ul><li>Recipient Government Responses </li></ul><ul><li>What is Coming in 2011? </li></ul>
  22. 22. Understanding DAH trends <ul><li>Public investment in DAH will be determined by three factors: </li></ul><ul><ul><li>Timing of fiscal contraction in order to reduce debt/GDP ratios. IMF estimates maximum contraction around 2013 </li></ul></ul><ul><ul><li>Priority attached to development assistance during fiscal contraction </li></ul></ul><ul><ul><li>Priority assigned to global health within development assistance </li></ul></ul><ul><li>Private investment in DAH likely to follow more closely the economic cycle and asset prices. </li></ul>
  23. 23. Good news… <ul><li>UK austerity budget includes expanded investments in development assistance. </li></ul><ul><li>GFATM replenishment at $11.7 billion for 2011-2013 was lower than projected needs but represents continued growth compared to 2008-2010 replenishment. </li></ul><ul><li>Is this a vote of confidence in GFATM or an early sign of global health’s continued priority more generally? </li></ul><ul><li>Will “preliminary estimates” from the GFATM secretariat of $1.1 billion eventuate? </li></ul>
  24. 24. Not so good news… <ul><li>Comparing 2006-2008 and 2008-2010, there is already evidence of declining or flat rates of growth for many donors. </li></ul><ul><li>Excluding US and UK bilateral, GAVI and GFATM, global health DAH peaked in 2008. </li></ul><ul><li>Continued expansion of global health driven to a large extent by these four channels. GAVI has no leader at present. US budget debate just beginning. </li></ul><ul><li>Broad “corridor discussions” in donor country Ministries of Finance of whether health has been overemphasized in recent years. </li></ul>
  25. 25. Outcome not predetermined <ul><li>The outcome of these key discussions is not predetermined by macro-economic circumstances. </li></ul><ul><li>By emphasizing evidence of the impact of past and current investments, the global health community can influence US and other decision-making on the priority for global health in times of general fiscal contraction. </li></ul><ul><li>Commitment to rigorous monitoring and evaluation of DAH and of government financial response will be key to sustaining financing for global health in the short and medium term. </li></ul>

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