Financing global health: tracking development assistance for health from 1990 to 2007

The Lancet, Volume 373, Issue 9681, Pages 2113 - 2124
20 June 2009

By Nirmala Ravishankar PhD, Paul Gubbins BA, Rebecca J Cooley MED, Katherine Leach-Kemon MPH, Catherine M Michaud MD, Prof Dean T Jamison PhD, Prof Christopher JL Murray MD

Background

The need for timely and reliable information about global health resource flows to low-income and middle-income countries is widely recognised. We aimed to provide a comprehensive assessment of development assistance for health (DAH) from 1990 to 2007.

Methods

We defined DAH as all flows for health from public and private institutions whose primary purpose is to provide development assistance to low-income and middle-income countries. We used several data sources to measure the yearly volume of DAH in 2007 US$, and created an integrated project database to examine the composition of this assistance by recipient country.

Findings

DAH grew from $5·6 billion in 1990 to $21·8 billion in 2007. The proportion of DAH channelled via UN agencies and development banks decreased from 1990 to 2007, whereas the Global Fund to Fight AIDS, Tuberculosis and Malaria, the Global Alliance for Vaccines and Immunization (GAVI), and non-governmental organisations became the conduit for an increasing share of DAH. DAH has risen sharply since 2002 because of increases in public funding, especially from the USA, and on the private side, from increased philanthropic donations and in-kind contributions from corporate donors. Of the $14·5 billion DAH in 2007 for which project-level information was available, $5·1 billion was for HIV/AIDS, compared with $0·7 billion for tuberculosis, $0·8 billion for malaria, and $0·9 billion for health-sector support. Total DAH received by low-income and middle-income countries was positively correlated with burden of disease, whereas per head DAH was negatively correlated with per head gross domestic product.

Interpretation

This study documents the substantial rise of resources for global health in recent years. Although the rise in DAH has resulted in increased funds for HIV/AIDS, other areas of global health have also expanded. The influx of funds has been accompanied by major changes in the institutional landscape of global health, with global health initiatives such as the Global Fund and GAVI having a central role in mobilising and channelling global health funds.

Funding

Bill & Melinda Gates Foundation.

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