Strengthening Health Systems: Global Health Financing

A new research report "Financing Global Health 2010: Development assistance and country spending in economic uncertainty", by the Institute for Health Metrics and Evaluation (IHME) at the University of Washington, indicates that despite the worst global economic crisis in decades, public and private donors continue to donate generously to global health, though at a slower rate. 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 commitment to health in the developing world has grown dramatically over the last twenty years, with the  developing countries' governments increasing their spending on health. Read more

 The research shows that development assistance for health has grown 375% in the last decade-- from $5.66 billion in 1990 to $26.87 billion in 2010. Thailand, for example, has seen its health assistance explode from $2.3 million in 1990 to $67.9 million in 2008-- a staggering increase of nearly 3000%. But, when we look around the region, we find countries that receive far more aid than Thailand per person, including the Philippines, Cambodia and, most strikingly, the small island nations. Micronesia, for example, receives $161 per person, while Thailand receives only $1 per person.

However, IHME’s preliminary estimates show that the growth rate is slowing. Between 2004 and 2008, 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. The government and private donors in the US made up one-half of all funding in 2008. But the economic downturn has hit US-based NGOs hard, and the amount of health funding spent by them decreased by 24% from 2009 to 2010.

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.
Dr. Christopher Murray, Director of IHME, feels that, “Everyone in the global health community is worried about how the economic crisis is going to affect giving. 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.”

Spending on HIV/AIDS programs has continued to rise at a strong rate, making HIV/AIDS the most funded of all health focus areas. Dr Murray feels that this could partly be due to the fact that, "Advances in medications to combat HIV were among the main reasons that donors and NGOs started to rally together to form what we know today as the global health community. The legacy of the early fight against HIV has maintained a strong commitment to funding for HIV-related efforts, and this includes the U.S. President's Emergency Plan for AIDS Relief, the single largest amount of funding to combat HIV."

Funding for maternal, newborn, and child health received about half as much funding as HIV/AIDS as of 2008. Again, funding for non communicable diseases represents just 0.5% of all development assistance for health.

Both, malaria and tuberculosis 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. Instead, the countries that receive the most money in proportion to their malaria burden include Georgia, Sri Lanka, Azerbaijan, Uzbekistan, Nicaragua, Kyrgyzstan, Tajikistan, Honduras, and Guatemala. All of these countries received more than $2,000 per disability-adjusted life year, or DALY, between 2003 and 2008.

Why is it so? Dr Murray feels that “in part it’s because health assistance decisions are not made entirely based on need but also reflect longstanding economic and political ties between countries, some of which go back to colonial days.”

In countries whose 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 indicate that the intensified focus on certain health issues – such as maternal, newborn, and child health, non communicable 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.”
Whatever the compulsions of funding agencies/beneficiary governments be, Dr Murray believes that 'when a program is started it should include an evaluation component so that everyone will have a detailed understanding of whether the program is improving health. This is gives developing country governments guidelines for how to best target their limited resources, which is actually the most important factor in health spending. Spending by governments on their own health programs on the whole far outweighs spending by donors.'

Shobha Shukla - CNS
(The author is the Editor of Citizen News Service (CNS) and also serves as the Director of CNS Diabetes Media Initiative (CNS-DMI). She has worked earlier with State Planning Institute, UP.  Email:, website:  

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