Gloomy economic forecasts notwithstanding, donations to health projects in developing countries appear to be holding steady. After reaching a historic high of $ 28.2 billion in 2010, development assistance for health dropped in 2011 but recovered in 2012. 

According to a new research from the Institute for Health Metrics and Evaluation (IHME) at the University of Washington, the strong growth in spending from GAVI Alliance and UNICEF counterbalanced declines in health spending among other donors. 

The new findings announced by the Centre for Global Development and published as part of the fourth annual edition of IHME’s financing series ‘Financing Global Health 2012: The End of the Golden Age’. 

This report tracks development assistance for health from government aid agencies, multilateral donors, and private foundations and charities. It explores funding trends over three periods — the moderate growth period from 1990 to 2001, the rapid growth period from 2001 to 2010 and the no growth period from 2010 to 2012.The research suggests that, despite global macroeconomic stress, the international community continues to respond to the need for health and health system support across the developing world. Over the past two years in particular, development assistance for health (DAH) has been sustained at levels of spending that would have been inconceivable a decade ago. The recent plateau in DAH, however, raises a number of considerations for decision-makers and other global health stakeholders. 

Priority setting has become even more important as global health funding has flat-lined. Many donors have been forced to re-evaluate funding decisions to adapt to a new global health landscape. From 2011 to 2012, overall health spending channelled through government aid agencies dropped by 4.4 per cent. Development assistance for health from the U.S. — the largest donor, dropped by 3.3 per cent, and health funding from France and Germany declined by 13 per cent and 9.1 per cent respectively. 

Among the six largest bilateral donors, donations only from the U.K. and Australia increased from 2011 to 2012. 

By combining health funding estimates with the results of the Global Burden of Disease Study 2010, the report provides metrics that can help inform donor priority setting. The GBD 2010 quantified premature death and disability, or disease burden, from 291 different diseases and injuries worldwide. Comparisons between the amount of development assistance for health that a country receives and its disease burden provide useful tools for assessing need versus funding. 

“This analysis highlights the mismatch between donor priorities and global health needs,” said Amanda Glassman, Director Global Health Policy and senior fellow at the Centre for Global development. “Before you can make a decision on where to allocate resources, you must first understand where that money is most needed,” she added. 

According to the report, many developing countries with the highest disease burden did not receive the most health funding. When comparing disease-specific funding and disease burden, such as malaria assistance versus burden of malaria, it becomes clear that certain countries receive much less funding than one might expect. For example, the low income countries Burundi, Guinea, Mali and Niger were among the top 20 countries in terms of malaria burden but were not among the top 20 recipients of malaria funding. 

The report further suggests that GAVI continued to have very strong rates of growth. In 2012, expenditure by GAVI reached an estimated $ 1.76 billion in 2012, a 41.9 per cent increase over 2011. 

The sub-Saharan African region received the largest share of health funding. In 2010 (the most recent year for which recipient-level estimates are available), sub-Saharan Africa’s share was $ 8.1 billion, of 28.7 per cent of total health funding.

Health funding for HIV/AIDS, tuberculosis, maternal, newborn and child health continued to grow through 2010. Development assistance for health sector support, non-communicable diseases, and malaria fell slightly from 2009-2010. Even at the peak of health funding from donors in 2010, the spending by governments on health in their own countries was $ 521 billion, more than 18 times higher than total donor funding in the same year. 

“There were predictions that the sky was going to fall on global health funding, but that did not happen. Only time can tell whether the stagnation will continue, but the global health community needs to be prepared either way,” IHME Director and report co-author Christopher Murray said. 

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