Visualizing stagnation: Funding stalled for global health

There’s plenty of moral and rhetorical support for fighting diseases of poverty, but if you look at global health spending trends lately the story is one of stagnation, or even decline.

As the Millennium Development Goals (aka the MDGs, a set of 8 anti-poverty goals established in 2000, the start of the new millennium) are nearing the15-year finish line, developing countries have made great progress in some areas, including significant reductions in child mortality and deaths from HIV/AIDS, tuberculosis, and malaria.

Yet an unacceptably high number of children and mothers continue to die in sub-Saharan African countries, and HIV/AIDS, tuberculosis, and malaria remain major killers. Even as the global community shifts focus to the next 15 years of pursuing the new agenda, as described by the Sustainable Development Goals, the need for donor assistance to achieve the unfinished MDG agenda persists.

Every year, the University of Washington’s Institute for Health Metrics and Evaluation (IHME) publishes estimates of the amount of money donors have provided to improve health in developing countries. The latest study, published today in the Journal of the American Medical Association, shows that development assistance for improving health in low- and middle-income countries dropped slightly between 2013 and 2014 (Figure 1).

Growth in funding stalled in 2011 and has been largely stagnant since then. The good news is that donors have invested $228 billion in health-related MDGs since 2000. Full disclaimer—I am a co-author on the study.

Figure 1: Development assistance for health, 1990-2014

Global Health Funding 2015

Source: IHME’s Financing Global Health data visualization tool, which is based on the study “Sources and Focus of Health Development Assistance, 1990-2014,” published in the Journal of the American Medical Association on June 16, 2015. (NGOs are non-governmental organizations, BMGF is Bill & Melinda Gates Foundation) 

The cost of the slowdown in development assistance for health following the global economic crisis is substantial. If growth had continued at the pace seen in the last decade, up to $38 billion more would be available for addressing health problems in developing countries.

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Looking across funding sources, the only governments who gave more money in 2014 than in 2013 were the United Kingdom, Australia, and Japan. The study also tracked funding from the organizations who channel money from sources to implementing institutions in developing countries, known as “channels.” Funding from the following channels grew between 2013 and 2014: the African Development Bank; UNICEF; the World Health Organization; the Bill & Melinda Gates Foundation; Gavi, the Vaccine Alliance; and the Swiss Agency for Development and Cooperation.

The research also reveals the fragility of funding for specific diseases, such as HIV/AIDS. Since the early 2000s, HIV/AIDS has benefited from the lion’s share of development assistance for health. However, the overwhelming majority of this funding (84%) came from a single source: the US (Figure 2). This makes funding for HIV/AIDS much more vulnerable to political and economic shifts in one country than an area like child health, which draws support from a much broader donor base (see Figure 3).

Figure 2: Development assistance for HIV/AIDS

GHFundingTwo

Source: IHME’s Financing Global Health data visualization tool, which is based on the study “Sources and Focus of Health Development Assistance, 1990-2014,” published in the Journal of the American Medical Association on June 16, 2015.

Figure 3: Development assistance for child health

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GHFundingThree

Source: IHME’s Financing Global Health data visualization tool, which is based on the study “Sources and Focus of Health Development Assistance, 1990-2014,” published in the Journal of the American Medical Association on June 16, 2015.

If the US cut its budget for HIV/AIDS funding dramatically under the next administration, which countries would feel the biggest impact from the cuts?

While many developing countries spend much more on their own health than donors do, in some countries, this does not hold true. Figure 4 shows the countries where donor funding for HIV/AIDS is greater than or equal to the amount the government spends on health. Many of these areas are countries that have received PEPFAR funding, such as Ethiopia, Haiti, Kenya, Mozambique, Malawi Uganda, and Tanzania.

Figure 4: Ratio of development assistance for HIV/AIDS to total health spending by developing country governments*

GHFundingFour

Source: IHME’s Financing Global Health data visualization tool, which is based on the study “Sources and Focus of Health Development Assistance, 1990-2014,” published in the Journal of the American Medical Association on June 16, 2015.

*Total health spending by developing country governments includes spending financed exclusively by domestic sources.

While great progress has been made in the fight against HIV/AIDS and the epidemic has peaked, there are more people living with HIV than ever before, a total of 29 million in 2013. Donor funding plays a major role in ensuring access to antiretroviral treatment in developing countries, so diversifying the portfolio of financing sources for this area is crucial for safeguarding the progress made in combating the HIV epidemic.

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About Author

Katie Leach-Kemon

Katherine (Katie) Leach-Kemon is a policy translation specialist at the Institute for Health Metrics and Evaluation (IHME). Katie specializes in two of IHME's research areas, the Global Burden of Disease and health financing. Katie has helped produce IHME's Financing Global Health report since it was first published in 2009. She received an MPH from the University of Washington and served as a Peace Corps volunteer in Niger. Her work has been published in The Lancet, Health Affairs, and the Journal of the American Medical Association. You can follow her on Twitter @kleachkemon.