Evolution and patterns of global health financing 1995–2014: development assistance for health, and government, prepaid private, and out-of-pocket health spending in 184 countries

Abstract This paper utilizes causal time-series and panel techniques to examine the relationship between development assistance for health (DAH) and domestic health spending, both public and private, in 134 countries between 2000 and 2015. Data on 237 656 donor transactions from the Institute for Health Metrics and Evaluation’s DAH and Health Expenditure datasets are merged with economic, demographic and health data from the World Bank Databank and World Health Organization’s Global Health Observatory. Arellano–Bond system GMM estimation is used to assess the effect of changes in DAH on domestic health spending and health outcomes. Analyses are conducted for the entire health sector and separately for HIV, TB and malaria financing. Results show that DAH had no significant impact on overall domestic public health investment. For HIV-specific investments, a $1 increase in on-budget DAH was associated with a $0.12 increase in government spending for HIV. For the private sector, $1 in DAH is associated with a $0.60 and $0.03 increase in prepaid private spending overall and for malaria, with no significant impact on HIV spending. Results demonstrate that a 1% increase in public financing reduced under-5 mortality by 0.025%, while a 1% increase in DAH had no significant effect on reducing under-5 mortality. The relationships between DAH and public health financing suggest that malaria and HIV-specific crowding-in effects are offset by crowding-out effects in other unobserved health sectors. The results also suggest policies that crowd-in public financing will likely have larger impacts on health outcomes than DAH investments that do not crowd-in public spending.

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Global Health Spending and Development Assistance for Health

JAMA ◽

10.1001/jama.2019.3687 ◽

2019 ◽

Vol 321 (21) ◽

pp. 2073 ◽

Cited By ~ 4

Author(s):

Joseph L. Dieleman ◽

Angela E. Micah ◽

Christopher J. L. Murray

Keyword(s):

Global Health ◽

Development Assistance ◽

Health Spending ◽

Development Assistance For Health

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Global health financing and Development Assistance for Health

Global Health Governance and Policy ◽

10.4324/9781351188999-13 ◽

2019 ◽

pp. 268-291

Author(s):

Eduardo Missoni ◽

Guglielmo Pacileo ◽

Fabrizio Tediosi

Keyword(s):

Global Health ◽

Development Assistance ◽

Health Financing ◽

Development Assistance For Health

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Factors associated with the disbursements of development assistance for health in low-income and middle-income countries, 2002–2017

BMJ Global Health ◽

10.1136/bmjgh-2020-004858 ◽

2021 ◽

Vol 6 (4) ◽

pp. e004858

Author(s):

Modhurima Moitra ◽

Ian Cogswell ◽

Emilie Maddison ◽

Kyle Simpson ◽

Hayley Stutzman ◽

...

Keyword(s):

Low Income ◽

Development Assistance ◽

Health Spending ◽

Recipient Country ◽

Health Systems Strengthening ◽

Low Income Countries ◽

Middle Income ◽

Development Assistance For Health ◽

Country Characteristics ◽

Health Accounts

IntroductionIn 2017, development assistance for health (DAH) comprised 5.3% of total health spending in low-income countries. Despite the key role DAH plays in global health-spending, little is known about the characteristics of assistance that may be associated with committed assistance that is actually disbursed. In this analysis, we examine associations between these characteristics and disbursement of committed assistance.MethodsWe extracted data from the Creditor Reporting System of the Organization for Economic Co-operation and Development, Institute for Health Metrics and Evaluation, and the WHO National Health Accounts database. Factors examined were off-budget assistance, administrative assistance, publicly sourced assistance and assistance to health systems strengthening. Recipient-country characteristics examined were perceived level of corruption, civil fragility and gross domestic product per capita (GDPpc). We used linear regression methods for panel of data to assess the proportion of committed aid that was disbursed for a given country-year, for each data source.ResultsFactors that were associated with a higher disbursement rates include off-budget aid (p<0.001), lower administrative expenses (p<0.01), lower perceived corruption in recipient country (p<0.001), lower fragility in recipient country (p<0.05) and higher GDPpc (p<0.05).ConclusionSubstantial gaps remain between commitments and disbursements. Characteristics of assistance (administrative, publicly sourced) and indicators of government transparency and fragility are also important drivers associated with disbursement of DAH. There remains a continued need for better aid flow reporting standards and clarity around aid types for better measurement of DAH.

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Future and potential spending on health 2015–40: development assistance for health, and government, prepaid private, and out-of-pocket health spending in 184 countries

The Lancet ◽

10.1016/s0140-6736(17)30873-5 ◽

2017 ◽

Vol 389 (10083) ◽

pp. 2005-2030 ◽

Cited By ~ 82

Author(s):

Joseph L Dieleman ◽

Madeline Campbell ◽

Abigail Chapin ◽

Erika Eldrenkamp ◽

Victoria Y Fan ◽

...

Keyword(s):

Development Assistance ◽

Health Spending ◽

Development Assistance For Health

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Official development assistance for health–how neglected are neglected tropical diseases? An analysis of health financing

International Health ◽

10.1016/j.inhe.2009.08.004 ◽

2009 ◽

Vol 1 (2) ◽

pp. 141-147 ◽

Cited By ~ 34

Author(s):

Bernhard H. Liese ◽

Liane Schubert

Keyword(s):

Neglected Tropical Diseases ◽

Development Assistance ◽

Health Financing ◽

Official Development Assistance ◽

Tropical Diseases ◽

Development Assistance For Health

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Operational challenges of engaging development partners in district health planning in Tanzania

10.21203/rs.3.rs-101223/v1 ◽

2020 ◽

Author(s):

Kusirye B Ukio ◽

James Charles ◽

Axel Hoffman ◽

Albino Kalolo

Keyword(s):

Quantitative Data ◽

Health Planning ◽

Descriptive Analysis ◽

Development Assistance ◽

Health Financing ◽

Health Priorities ◽

District Health ◽

Development Assistance For Health ◽

Donor Coordination ◽

The Government

Abstract Background: Development assistance for health represents an important source of health financing in many low and middle-income countries. However, there are few accounts on how priorities funded through Development assistance for health are integrated with district health priorities. This study aimed at understanding the operational challenges of engaging development partners in district health planning in Tanzania Methods: This explanatory mixed methods study was conducted in Kinondoni and Bahi districts. A structured checklist to 35 participants collected quantitative data whereas a semi-structured guide collected qualitative from 20 key informants (the council health planning team members and the development partners) to obtain information related to engagement of development partners in the planning processes and subsequent implementation of the district plan. We used descriptive analysis for quantitative data and thematic analysis for qualitative data Results: Majority (86%) of the development partners delivering aid in the studied districts were Non Governmental Organizations. We found high engagement of Development partners (DPs) (87.5%) in Bahi district and very low in Kinondoni district (37.5%). Guidance on district priorities to be included in Development partner’s plans as part of the Comprehensive Council Health Plan (CCHP) was given to 36% of the Development partners. Submission of written plans to be integrated in the District plans was done by only 56% of Development partners, with majority (77.7%) from Kinondoni district not submitting their plans. Only 8% of the submitted plans appeared in the final District plan document. Qualitative findings reported operational challenges to engagements such as differences in planning cycles between the government and donors, uncertainties in funding from the prime donors, lack of transparency, limited skills of district planning teams, technical practicalities on planning tools and processes, inadequate knowledge on planning guidelines among DPs and poor donor coordination at the district level. Conclusions: We found low engagement of Development partners in planning. To be resolved are operational challenges related to differences in planning cycles, articulations and communication of local priorities, donor coordination, and technical skills on planning and stakeholder engagement.

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Development Assistance for Health

10.1093/oso/9780198813057.003.0006 ◽

2018 ◽

Author(s):

Jeremy Youde

Keyword(s):

Global Health ◽

International Society ◽

Development Assistance ◽

Economic Recession ◽

Foreign Assistance ◽

Development Assistance For Health ◽

Past Generation ◽

Health Funding ◽

Private Corporations ◽

Donor States

Since 1990, development assistance for health has increased approximately 500 per cent. This incredible growth is one concrete manifestation of governments’ recognition of the importance of global health within international politics. It is all the more incredible because it has continued even in times of economic recession and a generalized decrease in foreign assistance by donor states. The increase in funding for global health also demonstrates the changes in the composition of significant actors within international society. No longer solely the province of state governments, global health funding increasingly comes from non-governmental organizations, philanthropic organizations, public–private actors, and even private corporations. The funding priorities also illustrate how international society has conceptualized global health. This chapter examines the changes within global health funding over the past generation and describes the successes and shortcomings of the current funding strategies.

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Tracking development assistance for health from China, 2007–2017

BMJ Global Health ◽

10.1136/bmjgh-2019-001513 ◽

2019 ◽

Vol 4 (5) ◽

pp. e001513 ◽

Cited By ~ 2

Author(s):

Angela E Micah ◽

Yingxi Zhao ◽

Catherine S Chen ◽

Bianca S. Zlavog ◽

Golsum Tsakalos ◽

...

Keyword(s):

International Development ◽

Development Assistance ◽

Health Financing ◽

Health System Strengthening ◽

Government Agencies ◽

Development Assistance For Health ◽

The World Bank ◽

Level Of Economic Development ◽

Current Context ◽

International Engagement

IntroductionIn recent years, China has increased its international engagement in health. Nonetheless, the lack of data on contributions has limited efforts to examine contributions from China. Existing estimates that track development assistance for health (DAH) from China have relied primarily on one dataset. Furthermore, little is known about the disbursing agencies especially the multilaterals through which contributions are disbursed and how these are changing across time. In this study, we generated estimates of DAH from China from 2007 through 2017 and disaggregated those estimates by disbursing agency and health focus area.MethodsWe identified the major government agencies providing DAH. To estimate DAH provided by each agency, we leveraged publicly available development assistance data in government agencies’ budgets and financial accounts, as well as revenue statements from key international development agencies such as the WHO. We reported trends in DAH from China, disaggregated contributions by disbursing bilateral and multilateral agencies, and compared DAH from China with other traditional donors. We also compared these estimates with existing estimates.ResultsDAH provided by China grew dramatically, from US$323.1 million in 2007 to $652.3 million in 2017. During this period, 91.8% of DAH from China was disbursed through its bilateral agencies, including the Ministry of Commerce ($3.7 billion, 64.1%) and the National Health Commission ($917.1 million, 16.1%); the other 8.2% was disbursed through multilateral agencies including the WHO ($236.5 million, 4.1%) and the World Bank ($123.1 million, 2.2%). Relative to its level of economic development, China provided substantially more DAH than would be expected. However, relative to population size and government spending, China’s contributions are modest.ConclusionIn the current context of plateauing in the growth rate of DAH contributions, China has the potential to contribute to future global health financing, especially financing for health system strengthening.

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