Wednesday, June 24, 2009

[EQ] Global health funding soars, boosted by unprecedented private giving

Global health funding soars, boosted by unprecedented private giving

But 12 of the 30 countries with the highest disease burden aren’t receiving as much aid as healthier, and, in some cases, wealthier countries

–Well-heeled donors, private corporations and average citizens sending money to their favorite charities are changing the landscape of global health funding, according to a new study by the Institute for Health Metrics and Evaluation (IHME) at the University of Washington.

Press release: http://healthmetricsandevaluation.org/resources/news/2009/Jun_18_2009.html

The Lancet, Volume 373, Issue 9681, Pages 2113 - 2124, 20 June 2009
Financing of global health: tracking development assistance for health from 1990 to 2007at:
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(09)60881-3/fulltext

“…..The research shows that funding for health in developing countries has quadrupled over the past two decades – from $5.6 billion in 1990 to $21.8 billion in 2007. Private citizens, private foundations and non-governmental organizations are shifting the paradigm for global health aid away from governments and agencies like the World Bank and the United Nations and making up an increasingly large piece of the health assistance pie – 30% in 2007. However, health aid does not always reach either the poorest or unhealthiest countries.

The study, Financing of global health: tracking development assistance for health from 1990 to 2007, appears in the June 20th issue of The Lancet and provides the first ever comprehensive picture of the total amount of funding going to global health projects. It takes into account funding from aid agencies in 22 developed countries, multilateral institutions like the World Health Organization and hundreds of nonprofit groups and charities. Prior to this report, nearly all private philanthropic giving for health was unaccounted for, meaning that nearly a third of all health aid was not tracked.

Overall, poor countries receive more money than countries with more resources, but there are strong anomalies. Sub-Saharan Africa receives the highest concentration of funding, but some African countries receive less aid than South American countries with lower disease burdens – like Peru and Argentina. Of the 30 low- and middle-income countries with the most illness and premature death, 12 are missing from the list of countries that receive the most health aid, including Angola, Ukraine and Thailand.

"With no one tracking this massive growth in spending, it’s no wonder that some countries receive far more than their neighbors for no immediately apparent reason,” said Dr. Christopher Murray, professor of global health and director of IHME at the University of Washington, and co-author of the study. "We’re hoping that this attempt to count money that has never been counted before in a careful and consistent way will lead to greater transparency and better use of health resources.”

Some small island nations with relatively healthy populations like Micronesia and the Solomon Islands receive more health aid per capita than disease-stricken countries like Niger and Burkina Faso. Mali and Colombia have about the same level of sickness, but Colombia receives three times as much health funding. The study also found that two of the world’s emerging economic super powers, China and India, receive huge amounts of health aid.

“We don’t know exactly why some countries seem to be far outpacing other countries, but historical, economic and political ties appear to be a factor,” said Nirmala Ravishankar, an IHME research scientist and the study’s lead author. “Some of these small islands are former colonies of the countries now giving them aid, and, in other cases, health aid seems to coincide with defense spending or drug interdiction efforts. This is an area that begs for more research.”

Where the money is being targeted within those countries also merits more scrutiny. Based on the research for 2007, HIV/AIDS receives at least 23 cents out of every dollar going into development assistance for health. Tuberculosis and malaria received less than a third of that, even though the combined burden for those diseases is greater than that from HIV/AIDS in developing countries and despite promises by G8 countries that those diseases would receive more funding. At the same time, about a nickel out of every dollar channeled to health assistance goes to system-wide health support – like funding for new clinics, doctor training and prevention programs – which is an area that global health experts have clearly identified as a priority.

The study also reveals other key findings:

·         The scale-up of global health funding doubled from 1990 to 2001 and then doubled again by 2007.

·         The growth has been driven largely by donations from the U.S. government and U.S.-based private charitable organizations. In sheer volume, the U.S. accounted for over 50% of total development assistance for health in 2007. But, in terms of the fraction of national income that becomes health aid, the U.S. trails Sweden, Luxembourg, Norway, and Ireland.

·         The Bill & Melinda Gates Foundation tops the list of private foundations providing global health aid, making up nearly 4% of all health assistance in 2007.

·         Food For The Poor, Population Services International and MAP International lead all non-governmental organizations (NGOs) in spending on health aid, each contributing more than $1 billion in health assistance from 2002 to 2006. Six of the top 10 NGOs are religious organizations.

·         In-kind contributions, such as donated drugs, made up more than 90% of the revenues of some of these NGOs, and they made up more than 50% of their total overseas health expenditure for most years during the study period. Because donations of drugs from pharmaceutical companies are sometimes valued at current market prices, this has potentially resulted in an exaggeration of the magnitude of resources flowing via US NGOs.

More details will be published in The Institute for Health Metrics and Evaluation (IHME)’s upcoming report, Financing Global Health 2009
University of Washington, Seattle, WA, USA

(N Ravishankar PhD, P Gubbins BA, R J Cooley MED, K Leach-Kemon MPH, Prof D T Jamison PhD, Prof C J L Murray MD); and Harvard Initiative for Global Health, Harvard University, Cambridge, MA, USA (C M Michaud MD)

Related Content:

·         See the figures

·         Download the slides (2.66MB ppt)

·         Map the data on IHME's GIS tool

The Lancet, Volume 373, Issue 9681 - 20 June 2009
An assessment of interactions between global health initiatives and country health systems
Health Organization Maximizing Positive Synergies Collaborative Group
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(09)60919-3/fulltext


            Editorial: Who runs global health? http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(09)61128-4/fulltext

 

What can be learned from data for financing of global health?

Peter S Heller, Paul H Nitze School of Advanced International Studies, The Johns Hopkins University, Washington
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(09)61132-6/fulltext

 

Address at the high-level dialogue on maximizing positive synergies between health systems and global health initiatives
Venice, Italy  22 June 2009
Why the world needs global health initiatives
Dr Margaret Chan, Director-General of the World Health Organization
http://www.who.int/dg/speeches/2009/global_health_initiatives_20090622/en/index.html



 

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This message from the Pan American Health Organization, PAHO/WHO, is part of an effort to disseminate
information Related to: Equity; Health inequality; Socioeconomic inequality in health; Socioeconomic
health differentials; Gender; Violence; Poverty; Health Economics; Health Legislation; Ethnicity; Ethics;
Information Technology - Virtual libraries; Research & Science issues.  [DD/ KMS Area]

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[EQ] Performance Incentives for Global Health: Potential and Pitfalls

Performance Incentives for Global Health: Potential and Pitfalls

Rena Eichler, Ruth Levine, and the Performance-Based Incentives Working Group
Center for Global Development, 2009

Available online at: http://www.cgdev.org/content/publications/detail/1422178/

“…..explore a new approach to health funding—the transfer of money or goods to patients or providers when they take health-related actions or achieve performance targets. Donors have traditionally paid for inputs—doctors’ salaries, medical equipment—in the hope that they would lead to better health. Performance incentives turn the equation on its head. They start with the result—more children immunized, for example—and let health workers and managers on the ground decide how to achieve them.

Performance Incentives for Global Health documents a host of experiences with incentives for maternal and child health care, tuberculosis, child nutrition, HIV/AIDS, chronic conditions and more. An accompanying short video (below) illustrates the use of performance incentives in Rwanda and Haiti and shares the perspectives of patients and health care workers. The evidence strongly suggests that incentives can improve health and strengthen health systems in a variety of settings.

As decision makers in developing countries and their donor partners look for practical ways to improve health-sector performance, real-world experiences show that they should look to performance incentives to complement increasing total spending on health.

Contents

Front Matter

Part I: More Health for the Money
Rena Eichler and Ruth Levine

o        Ch. 1: Money into Health

o        Ch. 2: Problems to Solve

o        Ch. 3: Using Performance Incentives

o        Ch. 4: Making Payment for Performance Work

o        Ch. 5: A Learning Agenda

Part II: Case Studies

o        Ch. 6: Latin America: Cash Transfers to Support Better Household Decisions
Amanda Glassman, Jessica Todd, and Marie Gaarder

o        Ch. 7: United States: Orienting Pay-for-Performance to Patients
Kevin Volpp and Mark Pauly

o        Ch. 8: Afghanistan: Paying NGOs for Performance in a Postconflict Setting
Egbert Sondorp, Natasha Palmer, Lesley Strong, and Abdul Wali

o        Ch. 9: Haiti: Going to Scale with a Performance Incentive Model
Rena Eichler, Paul Auxila, Uder Antoine, and Bernateau Desmangles

o        Ch. 10: Rwanda: Performance-Based Financing in the Public Sector
Louis Rusa, Miriam Schneidman, Gyuri Fritsche, and Laurent Musango

o        Ch. 11: Nicaragua: Combining Demand- and Supply-Side Incentives
Ferdinando RegalĂ­a and Leslie Castro

o        Ch. 12: Worldwide: Incentives for Tuberculosis Diagnosis and Treatment
Alexandra Beith, Rena Eichler, and Diana Weil

Index

Related Content

·         Download the slides from the launch event

·         Watch the video

·         Download the Performance Incentives brief



 *      *     *

This message from the Pan American Health Organization, PAHO/WHO, is part of an effort to disseminate
information Related to: Equity; Health inequality; Socioeconomic inequality in health; Socioeconomic
health differentials; Gender; Violence; Poverty; Health Economics; Health Legislation; Ethnicity; Ethics;
Information Technology - Virtual libraries; Research & Science issues.  [DD/ KMS Area]

“Materials provided in this electronic list are provided "as is". Unless expressly stated otherwise, the findings
and interpretations included in the Materials are those of the authors and not necessarily of The Pan American
Health Organization PAHO/WHO or its country members”.

------------------------------------------------------------------------------------
PAHO/WHO Website


Follow us on Twitter: http://twitter.com/eqpaho

Equity List - Archives - Join/remove: http://listserv.paho.org/Archives/equidad.html

 

    IMPORTANT: This transmission is for use by the intended recipient and it may contain privileged, proprietary or confidential information. If you are not the intended recipient or a person responsible for delivering this transmission to the intended recipient, you may not disclose, copy or distribute this transmission or take any action in reliance on it. If you received this transmission in error, please notify us immediately by email to infosec@paho.org, and please dispose of and delete this transmission. Thank you.