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Global health funding:

2001-2011 and beyond

By Mark Harrington

Treatment Action Group27 October 2011

Lille, France

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Global health funding has increased in

recent years.

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.

McCoy D et al. Health Policy Plan. 2009;24:407-417

The global health funding architecture

has become much more complex

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Global health commitments are larger

than disbursements

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Health Official Development Assistance (ODA)Commitments by Donor, 2001 & 2008

Total = $7.6 billion Total = $26.4 billion

2001 2008

US$ Billions

Notes: Amounts in gross US$ commitments. Health ODA combines data from four OECD CRS sub-sectors: (1) Health; (2) Population Policies/Programs and Reproductive Health(includes HIV/AIDS & STDs); (3) Water Supply/Sanitation; and (4) Other Social Infrastructure and Services - Social Mitigation of HIV/AIDS. Source: Analysis of data obtained viaonline query of the OECD Development Assistance Committee (DAC) Database and Creditor Reporting System (CRS), June 22, 2010.

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Health Official Development Assistance (ODA)Commitments by Donor, 2001 & 2008

Total = $7.6 billion Total = $26.4 billion

2001 2008

US$ Billions

Notes: Amounts in gross US$ commitments. Health ODA combines data from four OECD CRS sub-sectors: (1) Health; (2) Population Policies/Programs and Reproductive Health(includes HIV/AIDS & STDs); (3) Water Supply/Sanitation; and (4) Other Social Infrastructure and Services - Social Mitigation of HIV/AIDS. Source: Analysis of data obtained viaonline query of the OECD Development Assistance Committee (DAC) Database and Creditor Reporting System (CRS), June 22, 2010.

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U.S. Global Health Initiative (GHI) as a Share ofthe Federal Budget, FY 2012*

Federal Budget$3.7 trillion

*FY 2012 is Presidents Budget Request to Congress.Sources: Kaiser Family Foundation analysis of data from the Office of Management and Budget, Agency Congressional Budget Justifications, and Congressional Appropriations Bills.

Global HealthInitiative (GHI)

$9.8 billion

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Independent Agency

Labor Peace Corps

CDC

HomelandSecurity

Commerce

EPA

The White House

Defense

USDANIH

FDA

HRSAPEPFAR

HHSOGHAOPHS

MCC

PMI

Water forPoor

NTDProgram

Department

Multi-AgencyInitiative

Dept. Operating Unit

CONG

RESS

Notes: GHI: Global Health Initiative; PEPFAR: Presidents Emergency Plan for AIDS Relief; PMI: Presidents Malaria Initiative ; NTD: Neglected Tropical Diseases Initiative; MCC:Millennium Challenge Corporation; OGHA: Office of Global Health Affairs; OPHS: Office of Public Health and Science. Source: Kaiser Family Foundation, The U.S. GovernmentsGlobal Health Policy Architecture: Structure, Programs, and Funding; April 2009; White House, Statement by the President on Global Health Initiative, May 5, 2009.

The U.S. Governments Global Health Architecture

USAIDBureaus for: Global Health;

Economic Growth, Agriculture& Trade; Democracy, Conflict,

Humanitarian Assistance.Missions

KEY

Treasury

GHI

StateOGACOES

Ambassadors

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$3.3 $3.7$4.5

$5.9$7.5

$8.4$1.1

$1.5

$1.8

$1.4

$2.3$1.9

$1.8 $1.8

$8.9 $8.9

FY 2004 FY 2005 FY 2006 FY 2007 FY 2008 FY 2009 FY 2010 FY 2011

CR

Other Global Health

GHI Programs

U.S. Global Health Initiative (GHI) & Other U.S. GlobalHealth Funding, FY 2004-FY 2011

$4.4$5.2

$6.3

$7.3

$9.8$10.3 $10.8

In Billions

*FY 2011 is currently funded through a Continuing Resolution (CR) that provides funding at FY 2010 enacted levels. Amounts are rounded.Note: The GHI was created as an initiative in FY 2009. All prior years represent the same programs and accounts which were not yet referred to as the GHI.Sources: Kaiser Family Foundation analysis of data from the Office of Management and Budget, Agency Congressional Budget Justifications prepared by individual agencies,and Congressional Appropriations Bills.

$10.7

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Top 10 Countries, U.S. Global Health Initiative (GHI)HIV/AIDS Funding, by Total FY 2010 Funding

* = GHI PlusCountry

Source: Kaiser Family Foundation. The U.S. Global Health Initiative: A Country Analysis;February 2011.

In Thousands

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U.S. Global Health Initiative (GHI) Funding: GlobalTuberculosis (TB), FY 2001-FY 2012*

In Millions

*FY 2011 is currently funded through a Continuing Resolution (CR) that provides funding at FY 2010 enacted levels. FY 2012 is Presidents Budget Request to Congress.Note: The GHI was created as an initiative in FY 2009. All prior years represent the same programs and accounts which were not yet referred to as the GHI.Sources: Kaiser Family Foundation analysis of data from the Office of Management and Budget, Agency Congressional Budget Justifications, and Congressional Appropriations Bills.

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U.S. Global Health Initiative (GHI)Tuberculosis (TB) Countries, FY 2010

Source: Kaiser Family Foundation. The U.S. Global Health Initiative: A Country Analysis;February 2011.

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Results (HIV)

Global ART programs cost $14-2-$16.6 billion over the past decade.

Over the decade, ART for the 3.5 million patient initial cohort saves18.5 million life-years.

The corresponding gross discounted economic benefits amount to

$34.0 billion. The monetary benefits range from 81 percent to 287 percent of

program costs over the same period. These results suggest that, inaddition to the large health gains generated, the economic benefits oftreatment will substantially offset, and likely exceed, program costswithin 10 years of investment.

- S Resch et al.(2011) Economic Returns to Investment in AIDS Treatmentin Low and Middle Income Countries. PLoS ONE 6(10): e25310.doi:10.1371/journal.pone.0025310.

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Recommendations

Examine not only how much is raised but how it isspent and who benefits.

Create systematic global measurement systems forglobal health investments, disbursements, andimpact.

Strengthen the ability of civil society to serve as awatchdog on how governments, NGOs, the private

sector, and donor programs function to the benefit ofthe end-users and their communities.

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References

McCoy D, Chand S, Sridhar D. Global health funding: how much, where it comesfrom and where it goes. Health Policy & Planning. November 2009: 24 (6): 407-417. doi: 10.1093/heapol/czp026. Published online: July 1, 2009.

Kaiser Family Foundation. U.S. Global Health Policy. 2011. globalhealth.kff.org/.

OECD. Measuring aid to health. 2008. www.oecd.org/dac/stats/health.Resch S, Korenromp E, Stover J, Blakley M, Krubiner C, Thorien K, Hecht R, Atun R.

(2011) Economic Returns to Investment in AIDS Treatment in Low and MiddleIncome Countries. PLoS ONE 6(10): e25310.doi:10.1371/journal.pone.0025310.

http://www.oecd.org/dac/stats/healthhttp://www.oecd.org/dac/stats/health