Tracking Finance Allocation: Has progress been made?

It seems as though the Bill and Melinda Gates Foundation (BMGF) took the 2008 article by Sridhar and Batniji[1] on donor transparency to heart.  They funded a (what seems to be) follow up 2009 article on tracking development assistance by Ravishankar, N. et al. [2] To summarize, Sridhar and Batniji compared the disbursements of donations from 4 donors (including the BMGF) and compared it to the number of deaths caused by diseases and found there was a difference in donor priorities with a very rough estimate of the burden of disease.  They called for more transparency in donor disbursement to further make people aware of where the money was going and maybe where it should be directed.  It seems that the BMGF took up the challenge and funded a study that explored development assistance for health (DAH) over 7 years.  The study provided an in-depth overview of funding sources, channeling of assistance, country origin of funding, types of transfers, etc.  They also ranked countries in order of how much DAH they received vs. countries with the greatest all-cause disease burden.  Very few countries exhibited a match or a close match of their funding vs. their DALYs; most countries received less money than what their all-cause disease burden seem to require.

The 2009 article brought up several other points to consider.  Their data showed a decrease in the amount of assistance going to UN agencies and development banks and they specifically point to a suggestion of the WHO changing its current role.  This data seemed to back up Barry R. Bloom’s article on the WHO’s lack of transparency and loss of trust.[3]  Their data also seemed to agree with Sridhar and Batniji’s data of an unequal amount of funding directed towards improving health-systems.

Finally the article brings up the need for transparency within governments to see where they are actually allocating the disbursements.  In doing a brief search, I found another study funded by BMGF that studies this.  This article by Lu, et al. [4] shows an increase in healthcare spending in all regions studied except for Sub-Saharan Africa.

I have to applaud the BMGF’s efforts in taking up the challenge from Sridhar and Batniji and hopefully it will inspire other donor’s to channel funds where it’s actually needed and countries to invest more in healthcare.


[1] Sridhar, D. and Batniji, R.  Misfinancing global health: a case for transparency in disbursements and decision making.  Lancet. 2008;372:1185 – 91,

[2] Ravishankar, N., et al.  Financing of global health: tracking development assistance for health form 1990 to 2007.  Lancet. 2009;373:2113 – 24.

[3] Bloom, Barry R.  WHO needs change.  Nature. 2011;143-145.

[4] Lu, C. et al.  Public financing of health in developing countries: a cross-national systematic analysis.  Lancet.  2010; 375:1375 – 87.


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