The latest snapshot on global health financing is in. Dr. Chris Murray and colleagues from The Institute for Health Metrics and Evaluation presented today the findings from IHME’s third annual report on global health financing, titled Financing Global Health 2011: Continued growth as MDG deadline approaches. Yes, the report states the well-known trend that global health financing has transitioned out of the “massive scale-up phase” (many arguing with huge consequences) and into a period of slower growth, similar to that seen during the 1990’s. But some of the latest tracking data shed light on some interesting trends, prompting many key questions.
- What’s the appropriate balance between government and non-governmental? – The 2011 IHME report just begins to scratch the surface of a critical choice having to be made by financers of global health – ‘should this sum of money be channeled through a national government or some non-governmental organization?’ With difficult trade-offs having to be made at the donor level, which route is going to provide the biggest return on investment, particularly with more calls to demonstrate the results generated from dollars spent? This question gains even more complexity when thinking about what gets funded, as Cristian Baeza, Director of the World Bank’s Health, Nutrition, and Population program, described at today’s event. With greater fiduciary oversight and a movement to link resources with results, Dr. Baeza expressed real concern about returning to practices of a decade ago, when donors “focused on commodities in the value chain, rather than systems.”
- Are developing countries stepping up? – Yes, the rate of growth for bilateral health funding is decreasing. Some are voluntarily backing away from previous commitments to the Global Fund. Others, like the US, are in a position where government spending cuts both scores political points in an election year, but are also a stark reality under the Budget Control Act of 2011. But, despite all of this, public investment in health continues to grow in many of the poorest regions around the world, namely East, Central, and West sub-Saharan Africa. In fact, government health expenditures as a source of financing nearly doubled in East sub-Saharan Africa between 2000 and 2009 ($1.69 billion to $3.26 billion). With continued calls for more country ownership, isn’t this the trend we should be most focused on improving? At the same time, however, “subadditionality” strongly persists, which shows funding intended for a Ministry of Health isn’t totally additional. Instead, the finance minster redirects intended MoH funding to another sector because of the incoming donor support for health. This naturally leads to another question of weighing health spending vs. non-health sector spending.
- Is health sector spending the more efficient and effective way to produce health? – UN member states gathered in Brazil late last year and declared their commitment to “take action on the social determinants of health.” Just a month earlier member states were in New York to agree on collective action to address the growing burden from non-communicable diseases, including through a “health in all policies” approach. So to achieve both aims, do we need to spend in health to produce health? As the question was rhetorically posed at today’s event, “If greater reductions for child mortality come from girls education, should we focus our increasingly constrained spending here?” Should we not prioritize funding for the things that produce the greatest health outcomes? Maybe, but in an era of “demonstrating results” and “returns on investment,” this becomes more complex trying to trace dollars and causality from one sector to another.
- What to do about shifts in the “bottom billion”? – Unfortunately, I didn’t hear anything on the issue today, but as Amanda Glassman and colleagues argued in a recent Center for Global Development working paper, our conceptualization of financing programs targeting the poorest and most vulnerable populations may require some re-conceptualizing. With donors often under stipulations regarding the types of countries they are able to give money to (this means middle-income countries, though they are now home to the largest population of poor people), will this at all influence preferred channels of assistance?
Dr. Murray and his colleagues continue to do great work providing a depiction of the increasingly complex network of actors and how global health dollars pass between them. Post your comments and let me know your thoughts on the emerging challenges in global health resource tracking.