Like every Friday, from Raj Nallari and Breda Griffith's lecture notes on Economic Policies for Poverty Reduction.
Development Assistance for Health – DAH
The Commission on Macroeconomics and Health (2001) concluded that the level of health spending in low income countries was insufficient to address their health challenges and that a scaling up of financing was needed in tandem with government-wide reform programs targeted towards the functioning and delivery of health services. Reform should aim to put in place stronger planning processes both within ministries of health and between them and the ministries of finance and planning. A concerted effort at the national level can in turn be supported by stronger collaboration among development partners providing assistance to various sectors and/or programs. The international community has an important role to play in supporting health in the development process.
Trends in DAH
Approximately 90 percent of total development assistance for health (DAH) comes from bilateral and multilateral agencies; the European Community (EC); the Global Fund to Fight AIDS, malaria and tuberculosis (GFATM); and grants provided by the Bill and Melinda Gates Foundation (BMGF) (Michaud, 2003).
Total DAH from the major sources identified above increased from US$6.4 billion on average between 1997–99 to US$8.1 billion in 2002, an increase of almost a quarter. The majority of the funds from both the public and private sources went to the GFATM.
Recent trends in development assistance for health (DAH) selected major sources of funds US$ thousands
Notes: (1) was not included in totals (pending update) to increase comparability of total DAH
Reflecting its recognized importance, health ODA has recently performed better than total ODA. Bilateral commitments for health ODA increased from US$2.6 billion on average in 1997–99 to US$2.9 billion in 2002. The largest increase in commitments came from the U.S. who pledged US$1.5 billion in 2003, from US$920 million three years previous (1997-1999). A further US$300 million from the bilateral donors was for multilateral agencies and the GFATM.
The UN agencies increased funding from US$1.6 billion to US$2 billion over the study period, the increase being largely due to the extra-budgetary contributions of the WHO. Contributions from the World Bank, after having increased over the 1990s, now stand at US$1 billion. Commitments from the BMGF amounted to US$0.6 billion in 2002.
Of the US$6.5 billion provided by the above donors, the largest share went to support country and regional activities (US$5.2 billion), with the remainder going to inter-regional and global activities (Michaud, 2003). More than one third of the funds went to Africa and US$1.25 billion was allocated to HIV/AIDS, malaria and tuberculosis. The U.S. was the largest donor for HIV/AIDS, committing US$790 million – more than double that of the next largest donor in 2002. GFATM allocated over half (56%) of total commitments to HIV/AIDS with 27 percent going for malaria and 15 percent to tuberculosis (Michaud, 2003). Thus, the largest increase in DAH was allocated towards fighting AIDS in Sub-Saharan Africa, (Exhibit below).
Top ten countries receiving most DAH from selected major sources (2002)
Countries with a total population of less than 1 million were not included
Source: Michaud 2003
The conclusions from the study on development assistance for health undertaken by Michaud (2003) may be summarized as:
- DAH maintained a steady level during the 1990s even when total ODA was falling;
- Allocation of DAH has been responsive to geographical needs, at least for HIV/AIDS, malaria and tuberculosis;
- The setting up of GFATM (as suggested initially by the CMH (2001)) has generated increased commitment from the developed world in fighting major health problems in developing countries;
- The allocation of funds increased by US$1.7 billion from 1997 to 2002 but continue to fall short of meeting real needs;
- Political commitment is at an unprecedented high, with, for example, the President of the U.S. having committed US$15 billion for 14 countries to fight AIDS over the next five years. (Michaud, 2002)
