PHM-Exch> Global health funding soars, boosted by unprecedented private giving

[Claudio Schuftan]

From: Ruggiero, Mrs. Ana Lucia (WDC) <ruglucia at paho.org>
crossposted from: EQUIDAD at listserv.paho.org

 *Global health funding soars, boosted by unprecedented private giving**

**But 12 of the 30 countries with the highest disease burden aren’t
receiving as much aid as healthier, and, in some cases, wealthier countries*

–Well-heeled donors, private corporations and average citizens sending money
to their favorite charities are changing the landscape of global health
funding, according to a new study by the Institute for Health Metrics and
Evaluation (IHME) at the University of Washington.

Press release:
http://healthmetricsandevaluation.org/resources/news/2009/Jun_18_2009.html

*The Lancet, Volume 373, Issue 9681, Pages 2113 - 2124, 20 June 2009
Financing of global health: tracking development assistance for health from
1990 to 2007at:
*
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(09)60881-3/fulltext

“…..The 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 citizens, private foundations and non-governmental
organizations are shifting the paradigm for global health aid away from
governments and agencies like the World Bank and the United Nations and
making up an increasingly large piece of the health assistance pie – 30% in
2007. However, health aid does not always reach either the poorest or
unhealthiest countries.

The study, Financing of global health: tracking development assistance for
health from 1990 to
2007<http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(09)60881-3/fulltext>,
appears in the June 20th issue of *The Lancet* and provides the first ever
comprehensive picture of the total amount of funding going to global health
projects. It takes into account funding from aid agencies in 22 developed
countries, multilateral institutions like the World Health Organization and
hundreds of nonprofit groups and charities. Prior to this report, nearly all
private philanthropic giving for health was 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.

"With no one tracking this massive growth in spending, it’s no wonder that
some countries receive far more than their neighbors for no immediately
apparent reason,” said Dr. Christopher Murray, professor of global health
and director of IHME at the University of Washington, and co-author of the
study. "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.”

Some small island nations with relatively healthy populations like
Micronesia and the Solomon Islands receive more health aid per capita than
disease-stricken countries like Niger and Burkina Faso. 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.

“We don’t know exactly why some countries seem to be far outpacing other
countries, but historical, economic and political ties appear to be a
factor,” said Nirmala Ravishankar, an IHME research scientist and the
study’s lead author. “Some of these small islands are former colonies of the
countries now giving them aid, and, in other cases, health aid seems to
coincide with defense spending or drug interdiction efforts. This is an area
that begs for more research.”

Where the money is being targeted within those countries also merits more
scrutiny. Based on the research for 2007, HIV/AIDS receives at least 23
cents out of every dollar 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, about a nickel out of
every dollar channeled to health assistance goes to system-wide health
support – like funding for new clinics, doctor training and prevention
programs – which is an area that global health experts have clearly
identified as a priority.

The study also reveals other key findings:

·         The scale-up of global health funding doubled from 1990 to 2001
and then doubled again by 2007.

·         The 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.

·         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.

·         Food For The Poor, Population Services International and MAP
International lead all non-governmental organizations (NGOs) in spending on
health aid, each contributing more than $1 billion in health assistance from
2002 to 2006. Six of the top 10 NGOs are religious organizations.

·         In-kind contributions, such as donated drugs, made up more than
90% of the revenues of some of these NGOs, and they made up more than 50% of
their total overseas health expenditure for most years during the study
period. Because donations of drugs from pharmaceutical companies are
sometimes valued at current market prices, this has potentially resulted in
an exaggeration of the magnitude of resources flowing via US NGOs.

More details will be published in *The** **Institute for Health Metrics and
Evaluation (IHME)’**s* upcoming report, *Financing Global Health** 2009
University of Washington, Seattle, WA, USA

*

(N Ravishankar PhD, P Gubbins BA, R J Cooley MED, K Leach-Kemon MPH, Prof D
T Jamison PhD, Prof C J L Murray MD); and Harvard Initiative for Global
Health, Harvard University, Cambridge, MA, USA (C M Michaud MD)

*Related Content:

*

·         See the
figures<http://healthmetricsandevaluation.org/resources/news/2009/Jun_18_2009.html#one%23one>

·         Download the
slides<http://healthmetricsandevaluation.org/print/articles/2009/financing_of_global_health_IHME_slides_0609.ppt>(2.66MB
ppt)

·         Map the data on IHME's GIS
tool<http://www.gcs-research.net/ihme/indicatorview/map/ihmeview.html?health=mrt.5q0&aid=aid.in&year=2004>

*The Lancet, Volume 373, Issue 9681 -* *20 June 2009*
*An assessment of interactions between global health initiatives and country
health systems
*Health Organization Maximizing Positive Synergies Collaborative Group
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(09)60919-3/fulltext

            *Editorial: Who runs global health?*
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(09)61128-4/fulltext



*What can be learned from data for financing of global health?*

*Peter S Heller, *Paul H Nitze School of Advanced International Studies, The
Johns Hopkins University, Washington
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(09)61132-6/fulltext



Address at the high-level dialogue on maximizing positive synergies between
health systems and global health initiatives
*Venice**, Italy**  22 June 2009
**Why the world needs global health initiatives*
Dr Margaret Chan, Director-General of the World Health Organization
http://www.who.int/dg/speeches/2009/global_health_initiatives_20090622/en/index.html
* *
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