Financing Global Health: the Story is Stagnation

Major gains in global health spending over the last decade are over.  This was the top line message from the 2012 edition of Financing Global Health, the fourth report in the series, which Chris Murray and Michael Hanlon of the Institute for Health Metrics and Evaluation recently presented at CGD.  The report shows that since 2010, the global health community has been in a stage of “no growth” or stagnation in development assistance for health (see chart below). However, the lack of growth since 2010 doesn’t mean that channels for spending have also remained constant, and the trend has been characterized by major shifts in the distribution of health funds. For example, over recent years GAVI, as a funding channel, has grown enormously as did some of the UN agencies (UNICEF mainly), while bilaterals and the Global Fund took the biggest hits.While stagnating growth in donor funding may seem like a bad thing to those in the field of global health, there appears to be a silver lining.   The report shows that there are very few health aid dependent countries: only four countries depend on aid for more than 45% of their total national health spending.  In fact, on average  developing country government spending dwarfs aid spending on health by a ratio of 18 to 1.There were plenty of other headlines, all of which deserve their own blog, but here are a few nuggets that stood out to me:

•  The United States is still by far the biggest total spender on global health, while Norway and Luxembourg lead the pack when contributions are measured as a share of GDP.
• The previous increases in growth were driven by US bilateral and Global Fund spending, mainly via US non-governmental organizations.
• There continues to be no rhyme or reason in the dollar per DALY allocations amongst countries, even when restricting to big 3 disease-specific DALYS. The range for HIV is between $0-$300 per HIV-related DALY with a disproportionate allocation to sub-Saharan Africa; $0-200 per malaria DALY with highest burden countries receiving the lowest dollar per DALY; $0-100 per TB DALY. For all three diseases, the US government, the Global Fund and the Bill & Melinda Gates Foundation fund majorities of total spending.
• Maternal and child health spending has risen and has the most diverse group of funders of the specific health areas studied. Non-communicable diseases continue to get almost nothing; less than $200 million in total.

 

• It includes funding from the multilateral development banks, foundations (including Gates and Bloomberg), UN agencies, public-private partnerships (for example, GAVI and Global Fund), and US non-governmental organizations. These institutions play a huge role in global health financing—and are often missed when only official sources of ODA or government spending are considered.
• It connects burden of disease by country and health focus area with development assistance for health (DAH) funding, allowing readers to visualize variation in the amount of DAH per disability adjusted life year (DALY) across countries. These figures also illustrate correlations (or lack thereof) between total disease burden and cumulative DAH in recent years.
• It includes estimates of government health expenditure in developing countries that help to place DAH in its proper context.