Financing of Global Health - IHME 0609

Financing Global Health 2009: Tracking development assistance for health June 18, 2009 IHME

Outline
About IHME (Slide 4)
About Financing Global Health 2009: Tracking development assistance for health (Slides 5-6)
Why measure development assistance for health? (Slides 7-8)
Findings (Slides 9-30)
Conclusion (Slides 31-32)
Next steps (Slide 33)

Global institute dedicated to:
gold-standard measurement and monitoring of population health and factors that determine health
evaluation of health initiatives, programs and systems performance
Funded by the Bill & Melinda Gates Foundation, the State of Washington, and other funders through individual research grants
Created in 2007 at the University of Washington
Institute for Health Metrics and Evaluation

Past two decades have seen an unprecedented upsurge in global health funding
Quality data on public and private resources for global health needed for policymaking as well as monitoring and evaluation
Major gaps exist in both methods for measuring health expenditures and available data
To help fill these gaps, IHME is tracking three major components of financial resource inputs for health: development assistance for health, government health expenditure, and private health expenditure
This first report – to be published annually – focuses on development assistance for health (DAH)
About Financing Global Health 2009

R apid rise in development assistance for improving health in low- and middle-income countries occurred over last decade
B ilateral agencies, multilateral organizations, and development banks dominated aid scene in the past
Several new global health actors playing increasingly important role in health assistance
Development assistance for health, 1990-2007

Lack of comprehensive data on health aid flows prior to this study
Extensive discussions about aid effectiveness and impact occurred in absence of comprehensive data on DAH
Before now, no comprehensive and consistent time-series data on external resource flows for health were available

Need for comprehensive and rigorous assessment of DAH
Timely and reliable data on development assistance for improving health in low- and middle-income countries are an essential ingredient for evidence-based and cost-effective policymaking
Data are also needed for monitoring whether donors are honoring their commitments and can foster greater transparency in aid reporting

New channels of assistance accounted for increasing share of DAH
Fraction of health assistance channeled via multilateral institutions like World Bank and United Nations (UN) agencies declined over time
Large and rapidly growing health expenditure from new actors – the Global Fund to Fight AIDS, Tuberculosis, and Malaria (GFATM) and the Global Alliance for Vaccines and Immunization (GAVI) – has occurred since 2002
First time NGOs’ contribution to DAH has been tracked
NGOs’ overseas health expenditure accounted for 25% of DAH in 2007 ($5.4 billion out of $21.8 billion)

DAH from 1990 to 2007 by channel of assistance Source: IHME DAH Database Channels of assistance: New actors

When delivering DAH, donor country governments exhibited different preferences in terms of channels of assistance 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. Source: IHME DAH Database Channel-wise composition of publicly financed DAH by donor in 2007

Upsurge in DAH from 1990-2007 fueled by public and private donations
DAH increased nearly fourfold from 1990 ($5.6 billion) to 2007 ($21.8 billion)*
DAH increased most rapidly from 2002 to 2007
On average, two-thirds of DAH came from public sources
Private philanthropy accounted for nearly 30% of health aid in 2007
In 2007, over 50% of private DAH came from donations from foundations, primarily Bill & Melinda Gates Foundation, and corporate donations of drugs and medical supplies
*real 2007 US$

Dramatic growth in DAH from 1990-2007 Source: IHME DAH Database DAH from 1990 to 2007 by source of funding

In-kind contributions in the form of technical assistance and drug donations constituted significant share of total health aid ($8.7 out of $21.8 billion in 2007)
Given current methods used to assign value to in-kind contributions, figures may be inflated
Commodities and technical assistance accounted for 40% of DAH

DAH composed of both monetary and in-kind transfers Source: IHME DAH Database DAH from 1990 to 2007 by type of assistance

US largest donor of DAH in absolute terms from 1990-2007
When taking total public and private donations into account, US was single largest contributor to DAH (1990-2007)
US public and private contributions represented 34.6% of total DAH in 1990, increasing to 51.1% in 2007

US public and private contributions accounted for growing share of total health aid flows Source: IHME DAH Database DAH from 1990 to 2007 by country of origin

Sweden, Luxembourg, Norway, and Ireland provide greater shares of national income to DAH than US 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. Source: IHME DAH Database and World Bank World Development Indicators Development assistance for health as a percent of national income, in 2007

US NGOs: Funding sources
Private donors most important source of revenue for US NGOs
In-kind donations of drugs and medical supplies from corporations accounted for nearly 50% of revenue in most years
Value of in-kind DAH may be inflated since donors (largely pharmaceutical companies) value them at current market prices

More DAH routed through US NGOs Source: IHME NGO Database Total overseas health expenditure by US NGOs from 1990 to 2007

Large share of DAH allotted to HIV/AIDS; smaller shares went to tuberculosis, malaria, and health sector support Source: IHME DAH and Project Databases DAH from 1990 to 2007 for HIV/AIDS, tuberculosis, malaria and health sector support

Disease-specific DAH
Of the $13.8 billion DAH in 2007, for which project-level information was available, $4.9 billion was for HIV/AIDS, compared with $0.6 billion for tuberculosis, $0.7 billion for malaria, and $0.9 billion for health-sector support
Despite emphasis on increasing funds for general health sector support, it remains a very small part of health aid, around 5% in 2007

HIV/AIDS funding dominated by US government and GFATM Source: IHME Project Database Development assistance for HIV, 1990 to 2007

Funding for malaria
Resources for malaria have not increased as much as expected, given donors ’ commitments (US President’s Malaria Initiative, G8 pledges)
GFATM and BMGF emerged as the two biggest channels of assistance for malaria

DAH for malaria increased substantially since 2005 Source: IHME Project Database Development assistance for malaria, 1990 to 2007

Higher disease burden and poorer countries tend to receive more health assistance
Total development assistance for health received by low- and middle-income countries positively correlated with burden of disease
Per-capita health assistance negatively correlated with per-capita income
Strong anomalies evident, however:
Three healthier middle-income countries – Colombia, Iraq, and Argentina – received large shares of DAH, while other poorer, sicker countries – like Mali, Niger, and Burkina Faso – received little funding

Sub-Saharan Africa receives most significant share of DAH compared to other regions Source: IHME DAH and Project Databases DAH from 1990 to 2007 by focus region

Top 30 country recipients of DAH for health from 2002 to 2007, compared with top 30 countries ranked by all-cause DALYs in 2002
Source: IHME Project Database and WHO Burden of Disease Database

Country allocation of DAH appears to be driven by considerations beyond burden of disease Source: IHME Project Database Top 10 recipients of development assistance for health from 2002 to 2007, disaggregated by channel of assistance

Geo-political and economic considerations influence DAH as well as ties between donor countries and their ex-colonies and protectorates Source: IHME Project Database and UN World Population Database Top 10 countries in terms of per capita development assistance for health received from 2002 to 2007, disaggregated by channel of assistance

Trends in development assistance for health, 1990-2007
Development assistance expanded greatly from 1990-2007, particularly post-2002
Private sources playing an increasingly important role in funding DAH
The increase in DAH fueled by huge expansion of dollars for HIV/AIDS, but other areas of global health also expanded dramatically
New actors in the field of global health such as GAVI, GFATM and NGOs competing for resources with other channels of assistance like World Bank and UN agencies, which may undermine these agencies’ neutral roles

Country- and disease-specific allocation of DAH
Our research reveals huge expansion of dollars for HIV/AIDS as well as increases in other types of disease-specific funding
Historical, economic and political factors unrelated to health may also determine which developing countries donor governments favor
Countries with higher disease burden and poorer countries tend to receive more aid

Future work
Provide annual assessment of DAH for enhanced debate on role of development aid in improving global health
Quantify aid spent on other diseases that affect developing countries besides HIV/AIDS, malaria, and tuberculosis
Use DAH data to assess effectiveness of aid
Further analyze if DAH flows to countries that need it most
Case studies of DAH at recipient country level
Examine impact of DAH on developing country governments’ spending on health

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Financing of Global Health - IHME 0609

by Institute for Health Metrics and Evaluation - University of Washington on Jan 16, 2010

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Financing of Global Health - IHME 0609 — Presentation Transcript