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Financing Global Health 2010: November 30, 2010 Christopher Murray Director Development assistance and country spending in economic uncertainty
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Financing Global Health 2010:
November 30, 2010
Christopher Murray
Director
Development assistance and country spending in
economic uncertainty
Outline
Why Track Development Assistance for Health?
Financing Global Health 2010 Methods
Key Findings on DAH
Recipient Government Responses
What is Coming in 2011?
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IHME’s work focuses on three questions
1. What are people’s health problems? – e.g., tracking adult, child, or maternal mortality; the Global Burden of Disease 2010
2. How well is society doing in addressing these health problems? – e.g., inputs, outputs, and outcomes from public health, medical care, and other key social determinants
3. What can be done in the future to maximize health improvement? – e.g., cost-effectiveness of major intervention and health system intervention options
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Tracking health financing
• Financing Global Health 2009 tracked Development Assistance for Health (DAH) – flows from key development-focused organizations for the advancement of global health.
• Financing Global Health 2010 tracks DAH and government health expenditures.
• Working on a systematic analysis of all available sources of data on out-of-pocket household expenditures on health for 1990-2010.
• Future editions of FGH will include all three components: DAH, government, and private expenditures on health.
Outline
Why Track Development Assistance for Health?
Financing Global Health 2010 Methods
Key Findings on DAH
Recipient Government Responses
What is Coming in 2011?
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Channels of development assistance for health
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NGO revision for in-kind revenue
• US NGOs claim drug and equipment donations at US wholesale prices, while the donors claim at production costs.
• On average, international prices are only one-quarter to one-fifth of US wholesale prices.
• We have estimated empirically this relationship and deflated all donations to all NGOs by the same average factor. NGO-specific deflators have not been possible to develop.
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Preliminary estimates for donors and agencies
• Financing Global Health 2009 and The Lancet results on financing global health through 2007 reflect the lag in audited financial statements.
• Using audited financial statements and tax returns, we have data for 2008.
• We have developed preliminary estimates for 2009 and 2010 by analyzing the historical relationship between budgets for donors and agencies and disbursements.
• Preliminary estimates for non-US government NGO revenue are the most uncertain.
Outline
Why Track Development Assistance for Health?
Financing Global Health 2010 Methods
Key Findings on DAH
Recipient Government Responses
What is Coming in 2011?
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DAH by channel of assistance, 1990-2010
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Total overseas health expenditures channeled through US NGOs by funding source, 1990-2010
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Fund balances for UN health-related agencies at the end of 2009
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DAH as a percentage of national income, 2008
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Public sector DAH by donor country received by channels of assistance, 2008
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Total DAH per-all cause DALY, 2003-2008
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Top 30 country recipients of DAH versus top 30 countries ranked by all-cause burden of disease
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DAH by health focus area
Scale-up most dramatic for HIV/AIDS, malaria, and tuberculosis.
Maternal, newborn, and child health aid slower but increasing.
NCDs less than $120 million per year in 2008.
Outline
Why Track Development Assistance for Health?
Financing Global Health 2010 Methods
Key Findings on DAH
Recipient Government Responses
What is Coming in 2011?
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Domestic financing of health by governments has been increasing
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What happens to domestic finance in countries that receive large amounts of DAH?
• Our analysis of how Ministries of Finance respond when governments receive DAH was published April 2010 in The Lancet.
• Responses vary substantially, but on average, finance ministries decrease health expenditures from their own sources by a range of 43 cents to $1.14 for every dollar of DAH received by governments.
• Debate is not about whether this occurs but whether it is welfare-enhancing.
• Perspectives vary widely between macro-economists and health specialists and between donors, Ministries of Health, and Ministries of Finance.
Outline
Why Track Development Assistance for Health?
Financing Global Health 2010 Methods
Key Findings on DAH
Recipient Government Responses
What is Coming in 2011?
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Understanding DAH trends
• Public investment in DAH will be determined by three factors:
o Timing of fiscal contraction in order to reduce debt/GDP ratios. IMF estimates maximum contraction around 2013
o Priority attached to development assistance during fiscal contraction
o Priority assigned to global health within development assistance
• Private investment in DAH likely to follow more closely the economic cycle and asset prices.
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Good news…
• UK austerity budget includes expanded investments in development assistance.
• GFATM replenishment at $11.7 billion for 2011-2013 was lower than projected needs but represents continued growth compared to 2008-2010 replenishment.
• Is this a vote of confidence in GFATM or an early sign of global health’s continued priority more generally?
• Will “preliminary estimates” from the GFATM secretariat of $1.1 billion eventuate?
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Not so good news…
• Comparing 2006-2008 and 2008-2010, there is already evidence of declining or flat rates of growth for many donors.
• Excluding US and UK bilateral, GAVI and GFATM, global health DAH peaked in 2008.
• Continued expansion of global health driven to a large extent by these four channels. GAVI has no leader at present. US budget debate just beginning.
• Broad “corridor discussions” in donor country Ministries of Finance of whether health has been overemphasized in recent years.
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Outcome not predetermined
• The outcome of these key discussions is not predetermined by macro-economic circumstances.
• By emphasizing evidence of the impact of past and current investments, the global health community can influence US and other decision-making on the priority for global health in times of general fiscal contraction.
• Commitment to rigorous monitoring and evaluation of DAH and of government financial response will be key to sustaining financing for global health in the short and medium term.
