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Visualizing health funding gaps in West and Central Africa

Global Health Financing IHME

Earlier this week, Humanosphere reported on the overall trends in funding for global health – fairly steady, mostly flat the last few years, and perhaps in need of a re-focus.

But which countries need help the most on the health front?

That critical question came up at the April 8 launch event for this report from the Institute for Health Metrics and Evaluation’s (IHME), Financing Global Health 2013: Transition in an Age of Austerity at the Center for Strategic and International Studies (CSIS) in Washington, D.C.

The question about which countries deserve the most aid is a complex question. IHME director Chris Murray pointed to key regional funding gaps identified in the study.

Chris Murray
Chris Murray

“If you are thinking ahead, then who do we need to help the most?” asked Murray. “Central and Western Africa and a few other fragile states have the worst health outcomes. We might need to strategically rethink what we’re doing to address problems in countries who are most at risk.”

A related paper was also published the same day in the journal Health Affairs.  J. Stephen Morrison, Senior Vice President and Director of the Global Health Policy Center at CSIS, chaired the launch event. The panel featured Murray and USAID Assistant Administrator for Global Health Ariel Pablos-Méndez.

You can watch the video of the global health financing event here:

The screen grab below from IHME’s new Financing Global Health visualization tool shows health funding compared to need in Africa.(Editor’s note: Go to this link and use the interactive tool. Fascinating and fun!)

Researchers at IHME compared the dollars of ‘development assistance for health’ per year of healthy life lost – also known as development assistance for health per disability-adjusted life year (DALY). This metric captures how much funding a country receives relative to the amount of suffering and early death it experiences.

IHME global health funding AfricaAs the screen grab above illustrates, Eastern and Southern Africa received the highest amount of dollars per DALY on the continent, while Western and Central Africa received much lower amounts.

For example, in Southern Africa, Botswana and Namibia received $110 and $83 dollars per DALY, respectively. In Eastern Africa, Tanzania received $26 per DALY, and Rwanda received $60. In contrast, most countries in West Africa obtained less than $20 per DALY: Ghana, Burkina Faso, and Mali received $19, $5, and $13, respectively. In Central African Republic, the majority of countries benefitted from $10 or less per DALY. The Democratic Republic of Congo, Central African Republic, and Republic of the Congo received $7.40, $4.50, and $10 per DALY, respectively.

As Dr. Murray mentioned at the CSIS event, data from the Global Burden of Disease Study 2010 indicate that West and Central Africa have some of the poorest health outcomes worldwide. They are also making some of the slowest progress in reducing early death and disability from a variety of communicable, newborn, and nutritional diseases. The next three screen grabs contrast progress in the top 10 causes of disease burden among children under 5 in Western, Central, and Eastern Africa between 1990 and 2010.

Causes of premature death and disability in Western Africa and percent change, 1990 and 2010:

WesternAfricaCauses of premature death and disability in Eastern Africa and percent change, 1990 and 2010:

EasternAfricaCauses of premature death and disability in Central Africa and percent change, 1990 and 2010:


In Central Africa, premature death and disability from all but one of the top 10 causes (lower respiratory infections) actually rose during this period. In contrast, Eastern Africa made much more progress than Central Africa. Disease burden from six of the top 10 causes decreased between 1990 and 2010 in this region. Western Africa made less progress than Eastern Africa: the region only succeeded in lowering early death and disability from three of the top 10 causes between 1990 and 2010. Also, progress in reducing the burden of lower respiratory infections, diarrheal diseases, and protein-energy malnutrition among children under 5 was slower in Western Africa compared to Eastern Africa.

At the conclusion of the launch event for the Financing Global Health report, Morrison asked the panelists at the event to name the main takeaways from the report for US legislators. Murray responded, “Evidence is starting to accumulate that funding is making a difference.”

These analyses indicate that if donors invest more global health dollars in Western and Central Africa as they have elsewhere on the continent, it may translate to accelerated health progress in these regions.

Katie Leach-Kemon, a weekly contributor of global health visual information posts for Humanosphere, is a policy translation specialist from the University of Washington’s Institute for Health Metrics and Evaluation.


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.