scholarly journals Development assistance for health: what criteria do multi- and bilateral funders use?

2017 ◽  
Vol 12 (2) ◽  
pp. 223-244 ◽  
Author(s):  
Trygve Ottersen ◽  
Aparna Kamath ◽  
Suerie Moon ◽  
Lene Martinsen ◽  
John-Arne Røttingen
Keyword(s):  
Economic Transition ◽  
Development Assistance ◽  
National Income ◽  
Economic Downturn ◽  
Limited Information ◽  
Middle Income ◽  
Development Assistance For Health ◽  
Middle Income Countries ◽  
Allocation Criteria ◽  
Broad Overview

AbstractAfter years of unprecedented growth in development assistance for health (DAH), the system is challenged on several fronts: by the economic downturn and stagnation of DAH, by the epidemiological transition and increase in non-communicable diseases, and by the economic transition and rise of the middle-income countries. This raises questions about which countries should receive DAH and how much, and, fundamentally, what criteria that promote fair and effective allocation. Yet, no broad comparative assessment exists of the criteria used today. We reviewed the allocation criteria stated by five multilateral and nine bilateral funders of DAH. We found that several funders had only limited information about concrete criteria publicly available. Moreover, many funders not devoted to health lacked specific criteria for DAH or criteria directly related to health, and no funder had criteria directly related to inequality. National income per capita was emphasised by many funders, but the associated eligibility thresholds varied considerably. These findings and the broad overview of criteria can assist funders in critically examining and revising the criteria they use, and inform the wider debate about what the optimal criteria are.

scholarly journals Distributing development assistance for health: simulating the implications of 11 criteria

2017 ◽  
Vol 12 (2) ◽  
pp. 245-263
Author(s):  
Trygve Ottersen ◽  
Suerie Moon ◽  
John-Arne Røttingen
Keyword(s):  
Low Income ◽  
Economic Transition ◽  
Development Assistance ◽  
National Income ◽  
Low Income Countries ◽  
Economic Downturn ◽  
Middle Income ◽  
Development Assistance For Health ◽  
Middle Income Countries ◽  
Almost All

AbstractAfter years of unprecedented growth in development assistance for health (DAH), the DAH system is challenged on several fronts: by the economic downturn and stagnation of DAH, by the epidemiological transition and increase in non-communicable diseases and by the economic transition and rise of the middle-income countries. Central to any potent response is a fair and effective allocation of DAH across countries. A myriad of criteria has been proposed or is currently used, but there have been no comprehensive assessment of their distributional implications. We simulated the implications of 11 quantitative allocation criteria across countries and country categories. We found that the distributions varied profoundly. The group of low-income countries received most DAH from needs-based criteria linked to domestic capacity, while the group of upper-middle-income countries was most favoured by an income-inequality criterion. Compared to a baseline distribution guided by gross national income per capita, low-income countries received less DAH by almost all criteria. The findings can inform funders when examining and revising the criteria they use, and provide input to the broader debate about what criteria should be used.

scholarly journals The challenge of middle-income countries to development assistance for health: recipients, funders, both or neither?

2017 ◽  
Vol 12 (2) ◽  
pp. 265-284 ◽  
Author(s):  
Trygve Ottersen ◽  
Suerie Moon ◽  
John-Arne Røttingen
Keyword(s):  
Development Assistance ◽  
National Income ◽  
Health Needs ◽  
Middle Income ◽  
Trade Off ◽  
Development Assistance For Health ◽  
Middle Income Countries ◽  
Recent Developments ◽  
Per Capita

AbstractRecent developments have transformed the role and characteristics of middle-income countries (MICs). Many stakeholders now question the appropriate role of MICs in the system of development assistance for health (DAH), and key funders have already recast their approach to these countries. The pressing question is whether MICs should be recipients, funders, both or neither. The answer has deep implications for individual countries and their citizens, and for the DAH system as a whole. We clarify the fundamental issues involved and emphasise a special feature of many MICs: mid-level gross national income per capita (GNIpc) combined with substantial health needs and large inequalities. We discuss the trade-off between concerns for capacity and need, and illustrate a capacity-based approach to setting the level of a GNIpc eligibility threshold. We also discuss how needs-based exceptions and incentive-preserving instruments can complement such a threshold. Against this background, we outline options for the future roles of MICs in various circumstances. We conclude that major players in the DAH system have reason to reconsider the criteria for allocating DAH among countries and the norms for which countries should contribute and how much.

scholarly journals Tracking Development Assistance for Health: A Comparative Study of the 29 Development Assistance Committee Countries, 2011–2019

2021 ◽  
Vol 18 (16) ◽  
pp. 8519
Author(s):  
Shuhei Nomura ◽  
Haruka Sakamoto ◽  
Aya Ishizuka ◽  
Kenji Shibuya
Keyword(s):  
Development Assistance ◽  
Health System Strengthening ◽  
Development Assistance Committee ◽  
Middle Income ◽  
Target Region ◽  
Development Assistance For Health ◽  
Middle Income Countries ◽  
Average Share ◽  
Sector Classification ◽  
Area Data

Development assistance for health (DAH) is an important part of financing healthcare in low- and middle-income countries. We estimated the gross disbursement of DAH of the 29 Development Assistance Committee (DAC) member countries of the Organisation for Economic Co-operation and Development (OECD) for 2011–2019; and clarified its flows, including aid type, channel, target region, and target health focus area. Data from the OECD iLibrary were used. The DAH definition was based on the OECD sector classification. For core funding to non-health-specific multilateral agencies, we estimated DAH and its flows based on the OECD methodology for calculating imputed multilateral official development assistance (ODA). The total amount of DAH for all countries combined was 18.5 billion USD in 2019, at 17.4 USD per capita, with the 2011–2019 average of 19.7 billion USD. The average share of DAH in ODA for the 29 countries was about 7.9% in 2019. Between 2011 and 2019, most DAC countries allocated approximately 60% of their DAH to primary health care, with the remaining 40% allocated to health system strengthening. We expect that the estimates of this study will help DAC member countries strategize future DAH wisely, efficiently, and effectively while ensuring transparency.

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

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.

scholarly journals A Systematic Review and Meta-analysis of Ventilator-associated Pneumonia in Adults in Asia: An Analysis of National Income Level on Incidence and Etiology

2018 ◽  
Vol 68 (3) ◽  
pp. 511-518 ◽  
Author(s):  
Ana Bonell ◽  
Ryan Azarrafiy ◽  
Vu Thi Lan Huong ◽  
Thanh Le Viet ◽  
Vu Dinh Phu ◽  
...  
Keyword(s):  
Meta Analysis ◽  
National Income ◽  
Carbapenem Resistance ◽  
Income Level ◽  
Incidence Density ◽  
Ventilator Associated Pneumonia ◽  
Middle Income ◽  
Middle Income Countries ◽  
Ovid Medline ◽  
Gram Negative Organisms

Abstract Background Ventilator-associated pneumonia (VAP) is the commonest hospital-acquired infection (HAI) in intensive care. In Asia, VAP is increasingly caused by resistant gram-negative organisms. Despite the global antimicrobial resistance crisis, the epidemiology of VAP is poorly documented in Asia. Methods We systematically reviewed literature published on Ovid Medline, Embase Classic, and Embase from 1 January 1990 to 17 August 2017 to estimate incidence, prevalence, and etiology of VAP. We performed a meta-analysis to give pooled rates and rates by country income level. Results Pooled incidence density of VAP was high in lower- and upper-middle-income countries and lower in high-income countries (18.5, 15.2, and 9.0 per 1000 ventilator-days, respectively). Acinetobacter baumannii (n = 3687 [26%]) and Pseudomonas aeruginosa (n = 3176 [22%]) were leading causes of VAP; Staphylococcus aureus caused 14% (n = 1999). Carbapenem resistance was common (57.1%). Conclusions VAP remains a common cause of HAI, especially in low- and middle-income countries, and antibiotic resistance is high.

scholarly journals The cost-effectiveness of hypertension management in low-income and middle-income countries: a review

2020 ◽  
Vol 5 (9) ◽  
pp. e002213
Author(s):  
Deliana Kostova ◽  
Garrison Spencer ◽  
Andrew E Moran ◽  
Laura K Cobb ◽  
Muhammad Jami Husain ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Low Income ◽  
Disease Risk ◽  
National Income ◽  
Economic Evaluations ◽  
Health Improvement ◽  
Middle Income ◽  
Middle Income Countries ◽  
Wide Range ◽  
The Cost

Hypertension in low-income and middle-income countries (LMICs) is largely undiagnosed and uncontrolled, representing an untapped opportunity for public health improvement. Implementation of hypertension control strategies in low-resource settings depends in large part on cost considerations. However, evidence on the cost-effectiveness of hypertension interventions in LMICs is varied across geographical, clinical and evaluation contexts. We conducted a comprehensive search for published economic evaluations of hypertension treatment programmes in LMICs. The search identified 71 articles assessing a wide range of hypertension intervention designs and cost components, of which 42 studies across 15 countries reported estimates of cost-effectiveness. Although comparability of results was limited due to heterogeneity in the interventions assessed, populations studied, costs and study quality score, most interventions that reported cost per averted disability-adjusted life-year (DALY) were cost-effective, with costs per averted DALY not exceeding national income thresholds. Programme elements that may reduce cost-effectiveness included screening for hypertension at younger ages, addressing prehypertension, or treating patients at lower cardiovascular disease risk. Cost-effectiveness analysis could provide the evidence base to guide the initiation and development of hypertension programmes.

Global burden of non-communicable diseases will rise

2016 ◽  
Keyword(s):  
Health Workers ◽  
Communicable Diseases ◽  
Middle Income ◽  
Non Communicable Diseases ◽  
Content Type ◽  
Policy Initiatives ◽  
Development Assistance For Health ◽  
Middle Income Countries ◽  
Health Infrastructure ◽  
Global Economic Growth

Significance In the same period, the share of deaths from communicable (or infectious) diseases has fallen from 30% to 23%. Yet there has been no corresponding shift in global development assistance for health, and policy initiatives to combat NCDs are minimal. Impacts NCDs will slow global economic growth as chronic sufferers will have limited productive capacities in the workplace. Health infrastructure in low- and middle-income countries will be increasingly overwhelmed and overburdened. Their health workers will be forced to shift their focus from treating communicable to non-communicable diseases.

scholarly journals The impact of physician migration on mortality in low and middle-income countries: an economic modelling study

2020 ◽  
Vol 5 (1) ◽  
pp. e001535
Author(s):  
Saurabh Saluja ◽  
Niclas Rudolfson ◽  
Benjamin Ballard Massenburg ◽  
John G Meara ◽  
Mark G Shrime
Keyword(s):  
Low Income ◽  
Excess Mortality ◽  
National Income ◽  
Economic Consequences ◽  
Economic Modelling ◽  
Middle Income ◽  
Physician Migration ◽  
Middle Income Countries ◽  
The Impact ◽  
Low And Middle Income

BackgroundThe WHO estimates a global shortage of 2.8 million physicians, with severe deficiencies especially in low and middle-income countries (LMIC). The unequitable distribution of physicians worldwide is further exacerbated by the migration of physicians from LMICs to high-income countries (HIC). This large-scale migration has numerous economic consequences which include increased mortality associated with inadequate physician supply in LMICs.MethodsWe estimate the economic cost for LMICs due to excess mortality associated with physician migration. To do so, we use the concept of a value of statistical life and marginal mortality benefit provided by physicians. Uncertainty of our estimates is evaluated with Monte Carlo analysis.ResultsWe estimate that LMICs lose US$15.86 billion (95% CI $3.4 to $38.2) annually due to physician migration to HICs. The greatest total costs are incurred by India, Nigeria, Pakistan and South Africa. When these costs are considered as a per cent of gross national income, the cost is greatest in the WHO African region and in low-income countries.ConclusionThe movement of physicians from lower to higher income settings has substantial economic consequences. These are not simply the result of the movement of human capital, but also due to excess mortality associated with loss of physicians. Valuing these costs can inform international and domestic policy discussions that are meant to address this issue.

scholarly journals Burden of Mesothelioma Deaths by National Income Category: Current Status and Future Implications

2020 ◽  
Vol 17 (18) ◽  
pp. 6900
Author(s):  
Odgerel Chimed-Ochir ◽  
Diana Arachi ◽  
Tim Driscoll ◽  
Ro-Ting Lin ◽  
Jukka Takala ◽  
...  
Keyword(s):  
National Income ◽  
High Income ◽  
Data Availability ◽  
Current Status ◽  
Mortality Data ◽  
Middle Income ◽  
Income Category ◽  
Middle Income Countries ◽  
Country Level ◽  
Income Status

Background: This study compares estimates of the global-level mesothelioma burden with a focus on how existing national mortality data were utilized and further assesses the interrelationship of country-level mesothelioma burden and asbestos use with national income status. Methods: Country-level mesothelioma deaths in the WHO Mortality Database as of December 2019 were analyzed by national income category of countries in terms of data availability and reliability. Numbers of mesothelioma deaths from the study of Odgerel et al. were reanalyzed to assess country-level mesothelioma death burdens by national income status. Results: Among 80 high-income countries, 54 (68%) reported mesothelioma to the WHO and 26 (32%) did not, and among 60 upper middle-income countries, the respective numbers (proportions) were 39 (65%) countries and 21 (35%) countries, respectively. In contrast, among 78 low- and lower middle-income countries, only 11 (14%) reported mesothelioma deaths while 67 (86%) did not. Of the mesothelioma deaths, 29,854 (78%) were attributed to high- and upper middle-income countries, and 8534 (22%) were attributed to low- and lower middle- income countries. Conclusions: The global mesothelioma burden, based on reported numbers, is currently shouldered predominantly by high-income countries; however, mesothelioma burdens will likely manifest soon in upper middle-income and eventually in low and lower middle-income countries.

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