TODAY -

The Mismatch Between Donor Priorities And Global Health Needs

Shobha Shukla *

Financing Global Health 2012: The End of the Golden Age?
Pix - Institute of Health and Metric Evaluation (IHME) Website



The recently released fourth annual edition of the financing series of the Institute of Health and Metric Evaluation (IHME), 'Financing Global Health 2012: The End of the Golden Age?' (Link here) tracks Development Assistance for Health (DAH) from government aid agencies, multilateral donors, and private foundations. It also analyses health spending from governments in developing countries between 1990 and 2010. By combining health funding estimates with the results of the newly published Global Burden of Disease (GBD) Study 2010, the report provides metrics that can help inform donor priority setting. Comparisons between the amount of DAH that a country receives and its disease burden provide useful tools for assessing need versus funding.

"For some diseases, there is a clear disconnect between funding and burden measured by both mortality and disability," explained IHME Assistant Professor Michael Hanlon. "These comparisons serve as a guide for policymakers to discuss, reassess, and improve upon their health spending."

Here are some major findings of the report:

0 According to IHME's preliminary estimates, a total of $28.1 billion was disbursed in 2012 as DAH-'a $53 million drop from 2010. However, the long-term trajectory of DAH demonstrates the firm commitment of development assistance partners to realizing positive health outcomes globally.

0 From 2011 to 2012, overall health spending channelled through government aid agencies dropped by 4.4%. Among the six largest bilateral donors, only donations from the UK and Australia increased from 2011 to 2012 at rates of 2.3% and 8.1%, respectively, while those from the US, the largest donor, dropped by 3.3%. GAVI (formerly the Global Alliance for Vaccines and Immunization) continued to have very strong rates of growth with its expenditure reaching an estimated $1.76 billion in 2012, a 41.9% increase over 2011.

0 However, many developing countries with the highest disease burdens did not receive the most health funding. Certain countries received much less funding in comparison to their high disease burden. For example, the low-income countries of Burundi, Guinea, Mali, and Niger were among the top 20 countries in terms of malaria burden, but were not among the top 20 recipients of malaria funding. Of the top 20 countries with the highest all-cause disability adjusted life years (DALYs), only 12 were among the top 20 recipients of DAH. Only India Nigeria and Vietnam had comparable DAH and DALY levels, relative to other countries on the list. Many upper-middle-income countries – Russia, Brazil, Mexico, and Thailand– received particularly low DAH relative to their disease burden.

0 With respect to specific health focus areas, DAH for HIV/AIDS, tuberculosis, and maternal new-born child health (MNCH) continued to grow through 2010, while that for health sector support, non'communicable diseases, and malaria fell slightly from 2009 to 2010. Growth in DAH for MNCH and TB was impressive at 8.8% and 13.8%, respectively, from 2009 to 2010. NCDs constituted by far the smallest health focus area tracked, as total expenditure amounted to just $185 million or 0.8% of the total allocable DAH in 2010.

Excluding India, the top recipients of total DAH from 2008 to 2010, were sub-Saharan African countries which received the largest share of health-funding in 2010—$8.1 billion or 28.7% of total health funding. India and South Africa, two middle-income countries, were among the top 10 recipients, highlighting the contradictions informing discussions about continued aid to middle-income countries.

With the exceptions of India and the Democratic Republic of the Congo, US bilateral assistance, played a prominent role in funding the top 10 recipients of DAH. In South Africa, US bilateral assistance comprised nearly 80% of DAH expenditure. In India, the UK contributed the biggest proportion of funds, making it the single largest recipient of UK aid. However, the UK Department for International Development (DFID) announced in November 2012 that it will be phasing out its aid to India and that existing programs should be completed by 2015.

DAH for HIV/AIDS

HIV/AIDS constituted the most substantial portion of DAH (30.5%) in 2010-'an increase of 2.8% over 2009. US bilateral agencies funded more than half (58.8%) of DAH for HIV/AIDS, with $4 billion in DAH spent in 2010. GFATM was the second largest contributor at $1.4 billion. Even so, according to a report by the global advocacy group ONE in 2012, the world is not on track to reach the MDG HIV/AIDS targets as 8.4 million people are still in need of treatment and 2.5 million people continue to be infected annually.

UNAIDS estimates that additional $2 to $3 billion are required annually to meet treatment and prevention needs. Of the top 20 countries with the highest HIV/AIDS DALYs, 13 are located in sub-Saharan Africa. Notably, South Africa ranked first in both HIV/AIDS DAH and HIV/AIDS DALYs, followed by India. However, disconnects between burden and DAH existed for Cameroon, Myanmar, and Brazil, which had particularly low levels of HIV/AIDS DAH despite their high burden.

DAH for MNCH

By 2010 DAH expenditure on MNCH reached almost $5.2 billion, an 8.8% increase from 2009. The US was the single largest contributor to MNCH, spending approximately 17.1% of the total in 2010, followed closely by UNICEF (16.6%) and UNFPA (15.9%). GAVI also made up a major proportion of spending on MNCH in 2010 at 4.9% with spending in this health focus area increasingly concentrating on vaccinations.

Among the 10 countries with the highest MNCH DALYs, eight (all of which are low'or lower-middle-income countries) received the highest amounts of MNCH DAH. These included India on the top followed by Nigeria and Pakistan. China is the only upper-middle-income country ranked in the top 20 but it received vastly less MNCH DAH in relative terms, ranking 48th among recipients of cumulative MNCH. However, a number of upper-middle-income countries with lower DALYs (Argentina, Peru, and Colombia) received some of the highest levels of DAH for MNCH.

DAH for Malaria

In 2010 total DAH for malaria amounted to almost $1.9 billion, a decrease of 4.2% from 2009. The Roll Back Malaria Partnership identified a $3.6 billion gap in spending if global malaria targets are to be met by 2015. The countries afflicted with the highest malaria DALYs, are all low-income or lower-middle-income countries. China is the only upper-middle-income country to appear among the top 20 recipients of DAH for malaria. India is the only non'African country that ranks among the countries with the highest malaria burden.

DAH for tuberculosis

Worldwide, TB accounts for 2% of all DALYs, and ranks 13th in terms of causes of the disease. A total of $1.1 billion in DAH was spent on TB in 2010. GFATM contributed 39.4% of the funds and spent $432 million on TB in 2010. Bill and Melinda Gates Foundation also provided substantial support to TB programs, disbursing 24.2% of total TB DAH in 2010.

China, Russia, and South Africa and other upper-middle-income countries (Peru, Kazakhstan, and Brazil) were ranked among the top 20 recipients of cumulative TB DAH from 2008 to 2010. Kazakhstan and Peru in particular received large amounts of DAH for TB despite relatively small burdens.

Although contributions are expected to continue in coming years, the Global Tuberculosis Report 2012 estimates a funding gap of $1.4 billion for research and $3 billion for control and care annually between 2013 and 2015.

DAH for NCDs

Since 1990, the global burden of disease has shifted substantially away from communicable diseases to NCDs (which include cancer, diabetes, heart disease, and hypertension) and by 2010 NCDs had risen to 54% of global DALYs. However NCDs constituted the smallest health focus area tracked, as total expenditure fell 5.1% in 2010 and amounted to just $185 million or 0.8% of the total allocable DAH of $28.2 billion in 2010. As people live longer and communicable diseases are tackled better, NCDs will be an increasingly important issue for health systems in low'and middle-income countries.

The WHO has been one of the most consistent supporters of DAH for NCDs, providing $49 million or 26.5% of this funding in 2010. In recent years, the Bloomberg Family Foundation too has committed an increasing share of its resources to NCDs and now accounts for 42.7% of NCD DAH at $79 million.

DAH for health sector support

DAH for health sector support includes disbursements made directly to developing-country governments to spend on health system strengthening or other health priorities. The UK, which provides the most significant amount of DAH for health sector support, contributed $258 million in 2010, a 13.5% increase from 2009. DAH from the US for health sector support, meanwhile, decreased 14.5% from 2009 to 2010.

Although Financing Global Health 2012 focuses primarily on DAH, it does not undermine the role of government health expenditure (GHE) in covering the costs of health care in developing countries. Even at the peak of health funding from donors in 2010, the spending by governments on health in their own countries was $521 billion, which was more than 18 times higher than total donor funding in the same year.

As development assistance partners make decisions about new funding commitments, the shifts in DAH, as shown in the report, should be kept in mind. If DAH for malaria, non-communicable diseases, and health system support, continues to wane, decision-makers need to be cognizant of the impact. If bilateral spending continues to drop, the increasing prominence of other players must be taken into consideration.

Any retreat from DAH for middle-income countries will have to be observed closely, as 75% of the world's poor now reside in middle-income countries. Accurate and timely information, as provided by this report, is thus increasingly necessary to ensure that stakeholders are able to respond to a quickly evolving global health landscape and make informed decisions about a multitude of global health challenges. v "This analysis highlights the mismatch between donor priorities and global health needs," said Amanda Glassman, Director of Global Health Policy and a senior fellow at the Center for Global Development to Citizen News Service 'CNS. "Before you can make a decision on where to allocate resources, you must first understand where that money is most needed."


* Shobha Shukla, Citizen News Service 'CNS wrote this article for e-pao.net
The author is the Managing Editor of Citizen News Service 'CNS. She is a J2J Fellow of National Press Foundation (NPF) USA. She received her editing training in Singapore, has worked earlier with State Planning Institute, UP and taught physics at India's prestigious Loreto Convent. She also authored a book on childhood TB, co-authored a book (translated in three languages) "Voices from the field on childhood pneumonia", reports on Hepatitis C and HIV treatment access issues, and MDR-TB roll-out. Email: shobha@citizen-news.org, website: http://www.citizen-news.org .
This article was posted on February 26, 2013



* Comments posted by users in this discussion thread and other parts of this site are opinions of the individuals posting them (whose user ID is displayed alongside) and not the views of e-pao.net. We strongly recommend that users exercise responsibility, sensitivity and caution over language while writing your opinions which will be seen and read by other users. Please read a complete Guideline on using comments on this website.




LATEST IN E-PAO.NET
  • Pot Lannaba : Houchongba #1: Gallery
  • IM & Govt against freedom fighters
  • Wijaidin Pamai @Intl Fashion Week Goa
  • SheChef Season 2, Shirui Lily Festival 2019
  • Crazy for the hole :: Poem
  • Intl Classical Manipuri Dance Festival
  • Putting a check on single use plastic
  • Harvesting the green gold
  • Mera Houchongba @Kangla #1: Gallery
  • Mera Houchongba festival
  • Intl Day for Disaster Risk Reduction
  • Understanding JAM for bright career
  • For you, I gave up everything : Poem
  • Paranoia of Beauty: A Corporate Brainwash
  • Naga Peace Process :: News Timeline
  • Opening NE to outside world: Challenges ..
  • Contested Identity Along Myanmar Border
  • NNPGs mandated for solution: Isak
  • Wont walk path of capitulated peace: IM
  • 3-month deadline ..unacceptable: Hoho
  • Manipur Street in Manchester & Shirui Lily
  • A glimpse of Shirui Flower : Gallery
  • World within a World
  • Face of RaDiant Group
  • For the Common People :: Poem
  • Heart Camp at Senapati District Hospital
  • NDPP is 'verba non facta' : NPF
  • Swindling of Public Money
  • Bor khoiramba @Hiyangthang #2 : Gallery
  • Lansinganglu, Ahinglang : eMing
  • World Tourism Day @Noney #3 : Gallery
  • World Mental Health Awareness Week 2019
  • Manipur lost legacy- Merger Agreement #2
  • My aquamarine :: Poem
  • Rice for beauty
  • Stand off over flag and constitution
  • Suicide - Western docs, Psychologists...
  • Naga wont accept alien doc. as constitution
  • Manipuri Calendar 2020 :: Download
  • AMAND Cultural @Pune #1 : Gallery
  • Inner Line Permit (ILP) Demand : Timeline
  • NE Message of Cleaninness at Delhi
  • Research Support Officer @ Amethyst
  • 8th AGM/Annual Cultural of AMAND, Pune
  • Peace & conflicts studies as a career
  • College student leaders learn leadership
  • Reaffirming stand of 2016 unity
  • Mr. Chief Minister, clean the dirt...
  • Nongdol Leima @ JNMDA #2 : Gallery
  • Haloi Taret: Dangerous Beauty....
  • Difficult days ahead for Muivah
  • Manipur from Independence to Merger #3
  • World Mental Health Day, 2019
  • Traditional DJ
  • Cry of a Dying River - 96 :: Poem
  • ..district to State level : Shirui Lily Festival
  • Something is still not right
  • Chothe Achui Lin festival #2
  • Heritage Park @Sangai Fest #3: Gallery
  • Are we being bullied with same fake news?
  • Hard facts about the betrail
  • World Animal Day 2019
  • Academic Entrepreneurship at MU #2
  • Nagas of Nagaland : Drawing the divide
  • ... Manipur needs strategic change
  • World Tourism Day @Noney #2 : Gallery
  • ST status is to save indigenous community
  • Sangai festival and tourism multiplier
  • Governance, Gender & Environment :: Book
  • Now Your Hair :: Poem
  • Neiphiu Rio's myopic belief on ILP : NPF
  • Probe into maladministration of hospital
  • Taking high moral stand: Begone moral cop
  • Bor khoiramba @Hiyangthang #1 : Gallery
  • Manipur lost legacy- Merger Agreement #1
  • Sikkim Dance @Sangai Fest: Gallery
  • World Habitat Day: A celebration for home
  • For Your Eyes Only :: Poem
  • No School bag day in Manipur
  • Making ban on single use plastic effective
  • New CAB clause to protect NE : HM
  • NNPGs ready to conclude talks: Kitovi
  • 123rd Lamyanba Irabot #2 : Gallery
  • Ngangom Chaoba : Natyabhusan
  • Ganja economics, Jai Bholenath !
  • Soul Sister :: Poem
  • Leap of faith on wings of Prayer
  • Counselling: Children in Conflict with Law
  • Caution for the cocksure
  • CAB Protest @Khwairamband : Gallery
  • Manipuri Women & Crime Against them
  • Toward exploring a better future for youth
  • I happily cry :: Poem
  • NE Students' Culturals at Pondicherry
  • Beauty benefits of banana
  • Heart Camp at District Hospital, Chandel
  • Contained but final word yet to be said
  • Smart idea, bumbling idealists
  • Chingda Satpi Engellei #2 :: eRang
  • Facts & Opinions: Integration of Naga Area
  • Licypriya : Earth Day Network 'Rising Star'
  • Cry of a Dying River - 95 :: Poem
  • Khangminashi - V at Ibotonsana Hr Sec
  • Academic Entrepreneurship at MU #1
  • Vote BJP but protest: CAB Indecisive stand
  • Significance of Manipuri proverbs
  • Hathei Phanit (Chilli) #2: Gallery
  • Naga insurgency & peace condition #2
  • World River Day, 2019
  • Half Brother :: Poem
  • Youth Essay Contest: May 18 Memorial
  • Michelle Salam : Top Ten Cake Masters
  • Internal tussle within the Government
  • The humility of MK Gandhi & Manipur
  • Bhagyachandra Death Anniv @WB : Gallery
  • Why dont Manipur forget Merger Agreement
  • Let us celebrate Non Violence Day
  • Looking Forward to a Sexy Evening : Poem
  • Observance of Senior Citizen's Day
  • Turmeric in beauty care
  • Artists for NH7 Weekender, Meghalaya
  • Parking madness at commercial centres
  • Demise of a dream
  • 123rd Lamyanba Irabot #1 : Gallery
  • International Day Of Older Persons, 1 Oct
  • Licypriya : India Peace Prize : Gallery
  • Irabot the poet of the working class
  • October Calendar for Year 2019 : Tools
  • Licypriya Kangujam : India Peace Prize 2019
  • ST status demand for Meiteis widening rift
  • Certificate Course on Neuropsychology
  • Lining up stand against CAB
  • Remembering Lamyanba & his politics
  • Irabot Day & the practice of volunteerism
  • Lamyanba Hijam Irawat :: Read articles
  • Around India in 60 days
  • Nungleiband Massacre: Diary of Editor
  • Judo: Rishikanta, Roshibina, Kalpana
  • Heart of an empowering woman : Poem
  • Imphal Peace Museum: Best Design Award
  • Engaging with the young minds
  • Lai Khutsangbi & female power
  • Naga liberty or forced disintegration..
  • Irabot's letter to Assembly: 18 Oct 1948
  • Monika Ingudam: Natl Youth Icon Award
  • Heart Camp at District Hospital, Ukhrul
  • Swacchata Hi Seva at Lakoipat
  • Let 'tree' that was cut, be the last
  • World Tourism Day @Noney #1 : Gallery
  • Where All The Flowers Gone? #2: Gallery
  • The resurgence of Hijam Irabot
  • Naga insurgency & peace condition #1
  • World Heart Day 2019
  • Judo: L Sushila; M Bidyashori, T Inunganbi
  • The Killing Fields 2013-18 : News Timeline
  • Counselling: Children in Conflict with Law
  • Looking to increase revenue collection
  • Adapting with the changing time
  • Inamma - Film Scenes #1 :: eRang
  • Heritage Park @Sangai Fest #2: Gallery
  • Cry of a Dying River - 94 :: Poem
  • Reject false solutions to climate crisis
  • Career in Mass Communication
  • Ideals of Lamyanba Irawat
  • Laurels for Th Brinda, Ng Touthang
  • Performances to watch at NH7 Weekender
  • Protest in NE against CAB starting Oct 3
  • Bamboo bus shelter model developed
  • Noney to host World Tourism Day
  • Drought and the drainage issues
  • Marangwon @Kangkhui Khullen: Gallery
  • The flavor of Utsav Tarpon
  • Urgent Need to Reconsider Naga History
  • A woman :: Poem
  • Human Papilloma Virus & women's health
  • Meeting the Enemy at Nathu La
  • 'Outburst' of Thuingaleng Muivah
  • Concerns for media persons
  • Ibudhou Thangjing Haraoba #5 : Gallery
  • Licypriya Climate March @Angola :Gallery
  • Featured Front Page Photo 2019 #4: Gallery
  • Licypriya Climate March at Luanda :: Report
  • Workshop on Science Writing
  • Nurabi, nominated at Rio WebFest
  • Manipur retain Senior Women's NFC title
  • Robert Naorem : Best Intl Fashion Designer
  • Process of updating electoral roll
  • Ban on plastic use
  • Kartal Cholom @ Sangai Fest : Gallery
  • Reflection on Tolstoy, Irawat & Dr. Kamal
  • Local solution, local action for #GlobalGoals
  • In You I Find My Sunset :: Poem
  • ... denying rights in actual practice
  • Landslide: Are Mitigation measures effective
  • Emotional Intelligence: Yardstick for life skill
  • eNabling North East Award 2019
  • The debate over legalising ganja
  • The new MVA; how serious is the govt ?
  • Chothe Achui Lin festival #1
  • Lady E-Rickshaw driver inspires women..
  • M Shanker: Indian Achievers Award 2019
  • Softly Coo the Wild Pigeons :: Poem
  • Discussion on Manipur Merger Agreement
  • Irabot, one & only leader of oppressed mass
  • Start-up Manipur as a potential launch pad
  • Culture Students Foundation Day : Gallery
  • Eyek Tamba :: Learn Manipuri script
  • Territorial Integration, Flag or Constitution
  • Book published on Irabot Day: Download
  • In love with the night :: Poem
  • Maverick mind of Ram - Dedicated to Bar
  • Smoking- silent killer for your backbone
  • Revisiting Sept. 21 (1948 & 1949)
  • Where All The Flowers Gone? #1: Gallery
  • BCIM Corridor & China New Transportation
  • Alzheimer's Awareness Month
  • Cry of a Dying River - 93 :: Poem
  • Rally & Youth's Voice on Climate Change
  • Guwahati to Bangkok : Direct Flight
  • Stringent traffic rules in place
  • Time for immediate solution to climate crisis
  • Traditional Dress of Hmar : Gallery
  • Licypriya @UNESCO Forum, Angola: Gallery
  • World Ozone Day and Langban Tarpan
  • Protection of Land in Tamenglong: Meeting
  • Licypriya Kangujam at UNESCO : Report
  • 46th AMWJU Foundation Day : Gallery
  • Heikru Hidongba #2 : Gallery
  • 48th Foundation Day of RIMS : Gallery
  • Chaklam Khongchat Numit #4: Gallery
  • Mukna - indigenous game : Gallery
  • Hiyang Tanaba @Lamlai #1: Gallery
  • Babysana's last rites performed: Gallery
  • Tolloi, Ukhrul :: 360 Panorama View
  • Manipuri Calendar for 2019 : Download
  • SPONSORED ADS