SEATTLE – The worst global economic crisis in decades has
not stopped public and private donors from giving record amounts of
money to health assistance for developing countries, according to a
new report by the Institute for Health Metrics and Evaluation
(IHME) at the University of Washington.
The research shows that development assistance for health has
grown 375% from $5.66 billion in 1990 to $26.87 billion in 2010.
However, IHME's preliminary estimates show that the growth rate is
slowing. Between 2004 and 2008, the period of the most dramatic
increases in health funding, assistance grew by an annual average
of 13%. But between 2008 and 2010, the rate of growth was cut by
more than half to 6% annually. Most health funding has gone to the
countries with the greatest need, but researchers found striking
anomalies, including the fact that 11 of the 30 countries with the
highest number of people suffering from disease and high mortality
receive less health funding than countries with stronger economies
and lower disease burdens.
The report, Financing Global Health 2010: Development assistance
and country spending in economic uncertainty, will be released
today at the Council on Foreign Relations in New York. It provides
a comprehensive picture of the total amount of health funding
between 1990 and 2008 from aid agencies and governments in 23
developed countries, multilateral institutions such as the World
Health Organization, and hundreds of nonprofit groups and
charities. In addition, IHME developed new analytical methods that
draw on government budgets, expenditure patterns, and data from
funders to make preliminary estimates for 2009 and 2010, overcoming
a two-year lag in the reporting of health assistance.
"Everyone in the global health community is worried about how
the economic crisis is going to affect giving. We knew we couldn't
wait for two years to find out," Dr. Murray said. "Research has
shown that economic downturns don't usually have an immediate
effect on charitable giving, but we were still surprised to see
sustained growth through 2010."
The report documents the continued rise in health funding and
the effects of that funding on spending for health by governments
in developing countries. The report's findings include:
- Country governments and private donors are driving the
increases in development assistance for health. The US government
and private donors in the US made up one-half of all funding in
2008.
- US-based NGOs have been hit hard by the economic downturn, and
the amount of health funding spent by them decreased 24% from 2009
to 2010.
- Significant improvements in transparency make it easier to
track how health funds are being used. In 1990, 65% of all public
health funding from donor countries was considered "unspecified,"
with no information available about the primary recipient of the
funds. In 2008, that fraction had dropped to 1%. In the US, more
than 30% of all funding was unspecified as recently as 2007. By
2008, though, the US government reported detailed information for
100% of its health assistance.
- Spending on HIV/AIDS programs has continued to rise at a strong
rate, making HIV/AIDS the most funded of all health focus areas.
Funding for maternal, newborn, and child health received about half
as much funding as HIV/AIDS as of 2008.
- Malaria and tuberculosis are often included with AIDS as top
priorities in combatting infectious diseases, but both receive far
less funding than AIDS: $1.19 billion for malaria in 2008 and $0.83
billion for tuberculosis. Funding for malaria and tuberculosis also
appears to go to countries that do not have large groups at risk
for these diseases. For example, of the 30 countries that receive
the most malaria health funding adjusted for disease burden, only
three – Eritrea, Sao Tome and Principe, and Swaziland –
are located in sub-Saharan Africa, where malaria is most
acute.
- Despite much discussion about the need for general health
sector support, funding for that area has grown slowly since 2006.
Funding for noncommunicable diseases, another popular topic among
global health advocates, represents just 0.5% of all development
assistance for health.
- The commitment to health in the developing world grew
dramatically over the past two decades. Governments of developing
countries increased spending on health.
- In countries where governments receive significant donor
funding, development assistance for health appears to be partially
replacing domestic health spending instead of fully supplementing
it. Conversely, in countries that receive health funding mainly
through NGOs, government health spending appears to increase.
The researchers suggest that a likely drop-off in future health
funding may not yet be apparent because of multiyear commitments
made by governments in stronger economic times. They also indicate
that the intensified focus on certain health issues – such as
maternal, newborn, and child health, noncommunicable diseases, and
health sector support – is likely to magnify the competition
for limited resources and exacerbate the effects of any downturn in
development assistance for health.
"More than 300,000 mothers still die every year, and more than 7
million children die before the age of 5. Chronic diseases need
more attention, and countries need better health care
infrastructure," Dr. Murray said. "All of these pressing health
issues require funding, and it is becoming increasingly difficult
to balance competing needs."
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