Will A Global Funding Slowdown Push Back Health Programmes?

The global financial crisis has led to a slowdown in growth of funding to improve health in many developing countries. According to new research findings from the Institute for Health Metrics and Evaluation (IHME) at the University of Washington, “Stagnating funding from the United States and shortfalls at the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) indicate troubled future for development assistance for health, raising the possibility that developing countries will have an even harder time meeting the Millennium Development Goal deadline looming in 2015.”

Health funding through United Nations agencies stopped increasing in 2011, and the GFATM announced recently that it would make no new grants until 2014 due to funding shortfalls. Preliminary estimates indicate that health assistance channelled through the Global Fund declined by $529 million, or 16%, between 2010 and 2011.

Key findings from the report ‘Financing Global Health 2011: Continued Growth as MDG Deadline Approaches’, which was released recently by IHME, indicate that:

(i) The US has greatly slowed the pace of growth to 2% between 2010 and 2011, after a decade of rapid increases in development assistance.

(ii) Development assistance to non-governmental organizations increased by 8% from 2010 to 2011, after two years of drops in funding.

(iii) Growth in development assistance for HIV/AIDS, tuberculosis, and health sector support slowed between 2008 and 2009, whereas development assistance for malaria, non communicable diseases (NCDs), and maternal, newborn, and child health accelerated over the same period. However development assistance for NCDs was just 1% of total DAH in 2009, although NCDs represent 45% of the overall disease burden in developing regions.

(iv) Spending by country governments on health accelerated between 2008 and 2009, increasing from $368.46 billion to $410.50 billion, 16 times the total amount spent for development assistance for health (DAH).

(v) For every $1 of development assistance for health that governments receive, they redirect $0.56 on average from the health sector to other spending priorities.

(vi) Generally countries with the most significant disease burdens receive the most development assistance for health (with the exception of 12 high disease burden countries)

India received most of its aid (29%) in the form of loans and grants from development banks, primarily the World Bank, and was one of the top DAH recipients of Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM). UK was India’s second largest funder of DAH from 2004 to 2009, representing 23% ($873.62 million) of total health assistance received by India. In 2011, the UK decided it would only commit to sending aid to India until 2015, and pressure is mounting on its government to totally cut off aid to India.

According to Dr Michael Hanlon from the Institute for Health Metrics and Evaluation, “Ultimately, whether health outcomes improve within a country will be determined by how that country sets priorities. Aggregating across the set of countries we track, domestic government spending on health increased from $192 billion in 1999 to $410 billion in 2009. The pace of that increase was very fast, equal to 11% annually between 2007 and 2009. However, development assistance for health continued to increase through 2011, at a much slower rate of 4%.  So we are observing a global trend that more money is devoted to health, but the growth of those funds is slowing. For example, India has been receiving less aid in recent years. In 2011, development assistance for health to India dropped by nearly 10% from $771 million to $700 million. As a result of this global slowdown, in many countries policy makers will need to be more purposeful in setting priorities and allocating available resources than they have in the past.”

With funding shrinking globally, well planned and properly managed investments in health programmes in low/ middle income countries are a must. For example, the Avahan program, an India AIDS Initiative, which was funded by the Bill & Melinda Gates Foundation, is estimated to have prevented over 100,000 new HIV infections over a period of 5 years. The program targeted key at-risk groups but ultimately had a benefit for the broader population. IHME had also reported recently that something as simple as making sure that a home has at least one insecticide-treated bed net can lead to a 23% reduction in malaria-related child mortality; and that most of the world’s countries are reducing child mortality and maternal mortality more quickly than a decade ago.

In the opinion of Dr Hanlon “If governments modify their behaviour and reduce the trend of redirecting $0.56 on average from the health sector to other spending priorities, then more money would be devoted to health, which would result in measurably better health outcomes. Governments are spending more of their own money on health every year. When they receive significant sums of aid, they tend to shift a portion of their own money to other areas. The net effect, though, is still an increase in overall spending. For example, if a government spends $100 of its own money on health and receives $10 in health assistance, it ultimately spends a $104.40 on health instead of the full $110.”

“If policymakers are able to find new ways to better allocate resources, it would be a welcome response to the economic crisis. It is crucial for countries to set priorities to maximize the impact of all available funds. One area which needs improvement is transparency. Nongovernmental organizations, for example, receive millions in public and private funding, but they generally don’t make their country-level expenditure data publicly available. That makes it very difficult for researchers, policymakers and the public to make the kind of cost-effectiveness comparisons that are needed, especially in tough economic times.”

So efficient planning, innovative programmes and honest accountability could go a long way in tiding over tight pockets, and turning the dream of a healthy life into reality for the poorest of the poor .

Shobha Shukla - CNS
(The author is the Managing Editor of Citizen News Service (CNS). She is a J2J Fellow of National Press Foundation (NPF) USA. She has worked earlier with State Planning Institute, UP and taught physics at India's prestigious Loreto Convent. She also co-authored a book (translated in three languages) "Voices from the field on childhood pneumonia" published in November 2011 and a report on Hepatitis C and HIV treatment access issues in December 2011. Email: shobha@citizen-news.org, website: http://www.citizen-news.org)

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