Stanford attack of UW/Seattle study on global health funding itself under attack

Okay, this is a bit convoluted but see if you can follow.

The gist here is about how best to fund improvements in global health.

In 2010, Seattle researchers at the University of Washington’s Institute for Health Metrics and Evaluation published an analysis of global health spending and found a significant amount of ‘displacement’ – meaning foreign donations to fight HIV, malaria, TB or other scourges were allowing governments in poor countries to cut their own spending on health.

This is a problem because one of the primary goals in global health is to support local investment in health services and infrastructure.

Some used (arguably, misinterpreted) the UW study as evidence a lot of global health spending is misused or wasted. The Seattle number-crunchers weren’t actually saying that, of course. They were just pointing out that donors and aid organizations may need to build in better incentives to programs to avoid this counter-productive phenomenon.

But perhaps based on the concern that some were using the IHME study as evidence foreign health aid is a waste, some experts at Stanford University recently published their own analysis of the UW analysis and decided that there is “no evidence that international health is wasted.” Writing in PLoS Medicine, two experts with Stanford contend of the Seattle study:

(The) conclusions drawn from these data are unstable and driven by outliers…. While government spending may be displaced by development assistance for health in some settings, the evidence is not robust and is highly variable across countries. We recommend that current evidence about aid displacement cannot be used to guide policy.

Them’s fighting words for number crunchers.

David Roodman at the Center for Global Development weighs in with an article that appears Solomonesque with the headline “Don’t Believe Either Side” but then goes on to tut-tut the Stanford folks for a little bit of meta-analysis hand-waving. Roodman actually appears to come down somewhat on the Seattle side, saying the Stanford group’s use of data is, well, not convincing.

Similarly, Sanjay Basu at Global Health Hub really digs in (you need to be a serious data wonk to want to read it) and also comes away unconvinced that the critics have made their case.

Chris Murray, director of the UW Institute and lead author of the original study, had this to say:

“We are happy to see more researchers paying closer attention to development assistance for health, and we welcome further discussion and debate about the best way to overcome the challenges of missing data and difficult to reconcile budget figures… As for the critique from Rajaie Batnaiji and Eran Bendavid, we have been unable to replicate their analysis and therefore remain unconvinced that their approach to analyzing global health financing is valid. We went back and analyzed the data used for our 2010 paper with 1,152 different variants of our model and 91% showed a displacement effect. It’s important to note that the idea of governments spending their own funding elsewhere after receiving outside funding is not a new concept. To say now that displacement of country spending on health never occurs is inconsistent with a wide range of research on this topic.”


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Tom Paulson

Tom Paulson is founder and lead journalist at Humanosphere. Prior to operating this online news site, he reported on science,  medicine, health policy, aid and development for the Seattle Post-Intelligencer. Contact him at tom[at] or follow him on Twitter @tompaulson.