Those of us with little to no background on financing or economics may find the topic of Health Financing Around the World as somewhat confusing or even intimidating. However, it is a critical piece of global health, and grasping the essence could only be beneficial. In reading both Gottret/Schreiber’s “Health Financing Revisited” and Ravishankar, et al’s article “Financing of global health: tracking development assistance for health from 1990-2007”, I found the topic of development assistance for health (DAH) to be a useful entry point in this learning process, while answering questions regarding the broader topic of financing. Even so, while gaining a better grasp of concepts, there are still many questions left unanswered, along with frustrations at the many inconsistencies found in research and evaluation.
A Brief summary: The rise in DAH has changed the world of global health financing (Ravishankar, et al. 2009), especially since the development of the Millenium Development Goals. From 1990-2007, we saw a great increase in spending on International DAH from International donors across the world, with the greatest increase occurring after 2002 (Ravisahnkar, et al, 2009). Gottret/Schreiber expanded this to include Africa as a major focus, while accounting for “55% of all external financing, where other developing countries only received 9%”. Although there was a decrease of the amount funded to UN agencies (including the WHO and UNICEF), an increase was seen in NGO’s, private agencies, GAVI, the Global Fund to Fight AIDS, Tubeculosis, and Malaria. Although public funding was a major source, throughout this time period there was also a great increase in private philanthropy, such as the Bill and Melinda Gates Foundation, as well as increases in medical equipment and corporate drug donations (Ravishankar, 209). The majority of funding has been to disease specific initiatives, rather than the broader agenda of health system strengthening.
While Ravishankar presents us with a comprehensive assessment of DAH, Gottret/Schreiber’s presents a broader overview of health financing, including DAH, while defining the various systems seen throughout low, middle, and high-income countries. While both authors address large number of discrepancies and difficulties in researching the financing of DAH, Gottret offers more on the challenges and difficulties low and middle-income countries have with absorption and efficiency. They attempt to do this in the context of building capacity for aid effectiveness, absorption, fund disbursement, how priorities are addressed, absorptive capacity, “and critical macro conditions such as good governance, lack of corruption, sound financial institutions, human resources for public sector management and service delivery” (Gottret/Schreiber, 2006).
Implications: It seems then, that the challenges in procuring a clear picture of where funds are going, how they are being spent, renovating poor tracking systems, minimizing measurement and research challenges, and creating transparent donor and receiving institutions need to be addressed immediately and simultaneously to putting more attention on health system strengthening if we are to meet not only the MDG’s, but change the greater health system challenge and burden of disease. And I am left with wondering that after almost 20 years of funding through this arrangement, is the global health community prepared to make changes that allow for better allocation, better capacity building and systematic strengthening? Although at times it seems fruitless, I hang on to the belief that it is possible.
Gottret, P., Schieber, G., (2006). “ Health Financing Revisited, A Practioner’s Guide. Overview”. The International Bank for Reconstruction and Development/The World Bank. Washington, DC
Ravishankar, N, Gubbins, P, Cooley, R, Leach-Kemon, K, Michaud C.M., Jamison, D.T., Murray, C.J, (2009). “Financing of global health: tracking development assistance for health from 1990 to 2007”. The Lancet; 373:2113-24