Global health funding slows

Rich countries have funnelled billions of health care dollars, euros and yen into the developing world despite the worst economic downturn in decades, according to a study.

But the pace of giving has slowed considerably, said the report by the Institute for Health Metrics and Evaluations (IMHE) at the University of Washington.

After climbing 13% annually from 2004 through 2008, growth in health-related aid averaged 6% over the next two years, following the near meltdown of the US financial system, the study found.

"Everyone in the global health community is worried about how the economic crisis is going to affect giving," said IMHE director and lead author Christopher Murray.

"We were surprised to see sustained growth through 2010," he said, noting that the 2009 and 2010 figures are preliminary estimates.

Shift in distribution of giving

Total giving in 2010 is likely to reach a record 27 billion dollars (about R191 billion), fourfold the level in 1990.

A further drop-off, however, may be around the corner when multi-year commitments by donor countries expire, he warned.

The report using new statistical methods that have made a notoriously opaque process more transparent also reveals a shift in the distribution of giving.

Governments and private sources have stepped up donations, while funds from strapped non-governmental organisations (NGOs) dropped by 24% from 2009 to 2010.

France set the pace in boosting health aid by 116% since 2004, a steeper increase than any other major economy. At the same time, the study uncovered imbalances in how money was distributed.

HIV/Aids spending

Spending from all sources on HIV/Aids topped $6 billion (about R42.6 billion) in 2008, the last year for which a breakdown by disease is available, taking nearly as large a slice of the donor pie as all other health problems combined, the report showed.

Around 1.8 million people died from Aids -related causes in 2009, according to the World Health Organisation (WHO).

Development assistance in 2008 for tuberculosis and malaria which claimed 1.7 and 1.0 million lives last year -was $1.19 billion (about R8.4 billion) and $830 million (about R5.8 billion), respectively.

Funding for maternal, newborn and child health was half that allotted for HIV/Aids, though birth-related problems account for more than three million deaths per year.

Poor match between need and funding

There was also a poor match between need and funding for some of the world's poorest nations, especially in Africa.

And while the goal of boosting basic health care infrastructure has been widely embraced, dedicated funding has not materialised, the study found.

"It is hard for donor country governments to be accountable to their parliaments about where the money is spent" if it is not earmarked for a specific disease or problem, Murray said.

"Also, even if the rhetoric is there, lots of people remain deeply sceptical that it is an effective way to fund programs," he added.

An earlier study by IMHE, published in The Lancet, showed that funding over the last two decades has shifted substantially from public to private channels.

In 1990, UN agencies and development aid banks accounted for more than half of assistance dollars for health. By 2007, that share had dropped to 21%.

(Sapa, Marlowe Hood, December 2010)

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