Lancet studies examine aspects of global health funding

Jun 21 2009

"Global health funding boosted by private donors has quadrupled since 1990, but the extra money has not always gone to the right countries and diseases, according to a pair of studies released Friday," in the journal Lancet, AFP/Google.com reports (Hood, AFP/Google.com, 6/18).

In one study, WHO researchers examined the impact of various global health initiatives aimed at major diseases over the last decade, discovering "although global health initiatives (GHIs) had benefited millions, there was evidence that they held back the health systems of poor countries," the Press Association/Google.com writes.

The report indicated that "services not targeted by GHIs were sometimes left behind and aid from outside could lead to countries reducing their own health spending" and a dependency on GHIs for "drugs and medical equipment could compromise a country's opportunities to develop its own" (Press Association/Google.com, 6/18). Also, "[t]he report finds that healthcare workers have been lured away from government hospitals by the higher salaries paid by international organisations involved in AIDS and other disease programmes," The Guardian reports.

"The programmes have achieved much and must continue, [the report] adds, but they need to include targets for strengthening the general health systems of the countries where they are working," the Guardian writes (Boseley, Guardian, 6/19). "The financial crisis poses some fundamental questions about the way the international community uses its resources. And the response is that while we clearly need more funds for health, we also need to identify opportunities to deliver better results and value for money. Building stronger health systems and promoting greater synergies between health systems and individual health programmes are key to making this happen," said Carissa Etienne, assistant director-general of the WHO (Press Association/Google.com, 6/18).

Another study tracked the growth of annual global health aid spending from $5.6 billion in 1990 to $21.8 billion in 2007 and tried to pinpoint where the money went, AP/Google.com reports (Cheng, AP/Google.com, 6/18). Despite the growth in spending over two decades, the study revealed "the distribution of those extra dollars, euros and yen have disproportionately favoured nations whose health needs are not among the world's most urgent," AFP/Google.com writes.

For instance, "Bangladesh, which has the seventh highest burden of disease of countries that receive development assistance, in the world, received only $1 billion in funding between 2002 and 2007," while "Kenya received $1.2 billion during the same time period, but has the 20th highest disease burden," Forbes writes, adding there was a "33-fold difference between the aid received by Turkmenistan and Nicaragua, two countries with similar disease-burden rates."

Forbes writes, that while "[s]uch findings aren't controversial; it's well known that aid is awarded based on several factors, including income, political stability and relationships between recipient and donor countries," Christopher Murray, director of the Institute for Health Metrics and Evaluation at the University of Washington and a lead researcher on the study, "expects the study to invigorate an ongoing debate about transparency and efficiency in a field that is increasingly concerned with how aid is distributed."

The researchers analyzed a collection of "data from nearly two dozen governments, the U.N. Population Fund, the World Bank and the Bill & Melinda Gates Foundation, among several other donors," Forbes writes, revealing two major trends – "more money is now delivered through NGOs and foundations than in the past, and programs related to HIV/AIDS, tuberculosis and malaria comprise increasingly more of total aid" (Ruiz, Forbes, 6/18).

The researchers found that "[o]verall, poor countries receive more money than countries with more resources, but there are strong anomalies. Sub-Saharan Africa receives the highest concentration of funding, but some African countries receive less aid than South American countries with lower disease burdens – like Peru and Argentina," according to a press release. "With no one tracking this massive growth in spending, it's no wonder that some countries receive far more than their neighbors for no immediately apparent reason," said Murray, whose research was funded by the Gates Foundation (University of Washington release/EurekAlert!, 6/18).

Jennifer Kates, a vice president of the Kaiser Family Foundation, described the study as a "'critical piece of work' … because it's the first time researchers compiled a comprehensive list of the sources and cumulative amount of global health financing. A major obstacle to improved efficiency, she says, is the lack of coordination between donors. Without a central, public database for aid, donors often don't realize similar programs are funded in the same country. '[The study] shows that there's not necessarily a rational process to figure out where the money should go,' she says," Forbes writes (Ruiz, Forbes, 6/18).

The Wall Street Journal's Health Blog examines the shift in global health funding sources, writing, "Donations skyrocketed, while the proportion of funds flowing through old-school players (like the U.N. and the World Bank) fell" (Goldstein, "Health Blog," Wall Street Journal, 6/18). The study revealed "the Global Fund to Fight AIDS, Tuberculosis and Malaria, created in 2002, and the Global Alliance for Vaccines and Immunization (GAVI), set up in 2000 – handled more than 12 percent of assistance aid by 2007," and [t]he share of resources moving through NGOs nearly doubled from 13 to 25 percent over the same period. Several new private donors entered the arena as well, notably the Bill & Melinda Gates Foundation," which in 2007 provided four percent of global health aid, the AFP/Google.com writes.

"It is good that we have a more diverse set of actors and institutions in global health – we would not have seen a growth of 22 billion dollars if it was all flowing through the UN system," Murray said. "But there are certain core functions that only the United Nations – especially the WHO – can fulfill. The risk is that these functions may get neglected and underfunded" (AFP/Google.com, 6/18).

In the Lancet, a related editorial addresses the role of WHO in global health, while a comment piece examines, "What can be learned from data for financing of global health?"