Our former colleague Jeremy Shiffman has just published an article that concludes with a quote from a 2006 Rwandan government assessment that the share of health support going for AIDS was "grossly disproportionate in a country with a 3% infection rate" and represented a "gross misallocation of resources."
While Jeremy's paper uses this quote to raise the possibility of misallocation, the thrust of the paper is to examine the empirical proposition that AIDS funding is crowding out other types of health sector support. By analyzing the volumes of detailed data in the OECD's DAC database on donor commitments to the health sector, Jeremy is able to show that donor support for AIDS has grown from around 5% of total health commitments in 1992-3 to about 30% in 2003-5, a six-fold increase of AIDS' share.
But Jeremy also notes that total health funding has grown over this same period by a factor of 4 (from $2.7 billion to $11.1 billion in 2004 dollars). This growth in the total has meant that the increase in AIDS' share has not prevented the growth of other categories of health aid.
Figure 2, reproduced from his paper, shows that among the other three categories into which he has lumped donor health assistance, only family planning support (i.e. "population") has shrunk in real terms. Support for infectious disease control (other than HIV) and for health sector development have both grown - though at far slower rates than AIDS spending.
Figure 2
What Jeremy is unable to say on the basis of this data is what would have happened to these other funding categories in the absence of AIDS spending. Would they have grown more, absorbing the money that would have gone into AIDS? Or might they have grown even less than they have in the absence of the attention focused on international health by the drama of the AIDS epidemic?
This question also lies at the heart of the issue raised by the Rwandan government. The claim that health sector expenditures are "grossly misallocated" because of the overweening dominance of AIDS support, suggests that the same money could have been available for allocation to other Rwandan health sector needs. We simply do not know the answer to this question.
However, in looking towards the future we can be reassured by Jeremy's finding that funding for general health sector support is the fastest rising category in absolute terms in the years 2003-5. This may be partly due to the deceptive lumpiness of the multi-year commitments of several donors, but it may also be a rational response of the donor community to the observation that the vertical programs donors seem to prefer, like those to combat AIDS and other infectious diseases, will best function if constructed on the foundation of strong overall health systems.
*UPDATE: Jeremy's current contact email is [email protected], and his website is http://faculty.maxwell.syr.edu/jrshiffman/.
CGD blog posts reflect the views of the authors, drawing on prior research and experience in their areas of expertise.
CGD is a nonpartisan, independent organization and does not take institutional positions.
