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

Ottersen, Trygve; Kamath, Aparna; Moon, Suerie; Martinsen, Lene; Røttingen, John-Arne

doi:10.1017/s1744133116000475

Cited by 17 publications

(24 citation statements)

References 30 publications

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“…Researchers using these approaches often assume that the chosen objective is universal, when in practice donors and countries have their own goals and objectives and their preferred indicators of need (Ottersen et al. ; Grépin et al. ).…”

Section: Diagnostic Methodologymentioning

confidence: 99%

“…Moreover, these frameworks assign some level of optimal allocation to which de facto levels of allocations are compared. Researchers using these approaches often assume that the chosen objective is universal, when in practice donors and countries have their own goals and objectives and their preferred indicators of need (Ottersen et al 2017;Grépin et al 2017).…”

Section: Diagnostic Methodologymentioning

confidence: 99%

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Aligning Funding and Need for Family Planning: A Diagnostic Methodology

Fan¹,

Kim²,

Choi³

et al. 2017

Studies in Family Planning

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With limited international resources for family planning, donors must decide how to allocate their funds to different countries. How can a donor for family planning decide whether countries are adequately prioritized for funding? This article proposes an ordinal ranking framework to identify under‐prioritized countries by rank‐ordering countries by their need for family planning and separately rank‐ordering them by their development assistance for family planning. Countries for which the rank of the need for family planning is lower than the rank of its funding are deemed under‐prioritized. We implement this diagnostic methodology to identify under‐prioritized countries that have a higher need but lower development assistance for family planning. This approach indicates whether a country is receiving less compared to other countries with similar levels of need.

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Section: Diagnostic Methodologymentioning

confidence: 99%

Section: Diagnostic Methodologymentioning

confidence: 99%

Aligning Funding and Need for Family Planning: A Diagnostic Methodology

Fan¹,

Kim²,

Choi³

et al. 2017

Studies in Family Planning

View full text Add to dashboard Cite

show abstract

“…Development assistance for health tends to be phased out as countries develop economically, especially when measured as a share of total health spending. Eligibility criteria set by donors, such as the Global Fund for AIDS, Tuberculosis, and Malaria (the Global Fund), the World Bank's International Development Association, and Gavi, the Vaccine Alliance (Gavi), are linked to gross national income thresholds 22 . At a certain level of economic development, countries become ineligible to receive development assistance for health.…”

Section: Introductionmentioning

confidence: 99%

Evolution and patterns of global health financing 1995–2014: development assistance for health, and government, prepaid private, and out-of-pocket health spending in 184 countries

Dieleman¹,

Campbell²,

Chapin³

et al. 2017

The Lancet

213

156

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SummaryBackgroundAn adequate amount of prepaid resources for health is important to ensure access to health services and for the pursuit of universal health coverage. Previous studies on global health financing have described the relationship between economic development and health financing. In this study, we further explore global health financing trends and examine how the sources of funds used, types of services purchased, and development assistance for health disbursed change with economic development. We also identify countries that deviate from the trends.MethodsWe estimated national health spending by type of care and by source, including development assistance for health, based on a diverse set of data including programme reports, budget data, national estimates, and 964 National Health Accounts. These data represent health spending for 184 countries from 1995 through 2014. We converted these data into a common inflation-adjusted and purchasing power-adjusted currency, and used non-linear regression methods to model the relationship between health financing, time, and economic development.FindingsBetween 1995 and 2014, economic development was positively associated with total health spending and a shift away from a reliance on development assistance and out-of-pocket (OOP) towards government spending. The largest absolute increase in spending was in high-income countries, which increased to purchasing power-adjusted $5221 per capita based on an annual growth rate of 3·0%. The largest health spending growth rates were in upper-middle-income (5·9) and lower-middle-income groups (5·0), which both increased spending at more than 5% per year, and spent $914 and $267 per capita in 2014, respectively. Spending in low-income countries grew nearly as fast, at 4·6%, and health spending increased from $51 to $120 per capita. In 2014, 59·2% of all health spending was financed by the government, although in low-income and lower-middle-income countries, 29·1% and 58·0% of spending was OOP spending and 35·7% and 3·0% of spending was development assistance. Recent growth in development assistance for health has been tepid; between 2010 and 2016, it grew annually at 1·8%, and reached US$37·6 billion in 2016. Nonetheless, there is a great deal of variation revolving around these averages. 29 countries spend at least 50% more than expected per capita, based on their level of economic development alone, whereas 11 countries spend less than 50% their expected amount.InterpretationHealth spending remains disparate, with low-income and lower-middle-income countries increasing spending in absolute terms the least, and relying heavily on OOP spending and development assistance. Moreover, tremendous variation shows that neither time nor economic development guarantee adequate prepaid health resources, which are vital for the pursuit of universal health coverage.FundingThe Bill & Melinda Gates Foundation.

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“…Countries' eligibility for foreign aid often remain linked to their GNI per capita capita (GNIpc) or their World Bank lending group designation. According to Ottersen et al, while 13 out of 14 multilateral and bilateral donors currently use GNIpc as an explicit criterion to allocate resources, none incorporates a criterion based on sub‐level economic or health inequalities, such as the Gini coefficient, inequality in health expectancy (LEi), or the Inequality‐adjusted Human Development Index (IHDI) . Other multilateral donors have similarly overlooked the role of in‐country inequalities to determine DAH “graduation” criteria .…”

Section: Health and Aid In Middle‐income Countries: What Has Changed?mentioning

confidence: 99%

“…However, the complexity of this resource allocation process undoubtedly raises issues of fairness and efficiency. Indeed, many have criticized the lack of transparency and effectiveness of the complex decision calculus negotiated between donor countries, recipient countries, and myriad global institutions for aid …”

Section: Introductionmentioning

confidence: 99%

A New Golden Age? Proposal for an Innovative Global Health Funding Mechanism for Middle‐Income Countries

et al. 2017

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Despite economic growth and increased global commitment to health financing in the past decades, the health needs of some of the world's most vulnerable people remain overlooked. In particular, middle‐income countries (MICs) often face the conundrum of receiving reduced development assistance for health (DAH) while still being home to most of the world's poor and the majority of the global burden. We believe that this reflects shortcomings in the global DAH system's architecture, which operate on principles that do not respond well to current realities. Hence, we propose a novel mechanism for international health financing and action that specifically addresses the newly emerged strengths and needs of MICs. The Incentives for Health (I4H) Alliance will offer MICs flexible incentives in exchange for their making and meeting health‐related commitments in their countries. Countries can set their own health targets, in alignment with the existing Sustainable Development Goals' framework, and those that achieve them will be subsequently rewarded with financial or other incentives, which are not restricted to the health sector. We believe that the I4H Alliance will promote greater MIC involvement towards global health financing both as incentive providers and recipients; encourage collaboration between Ministries of Health and Finance; and provide a needed complement to traditional DAH mechanisms. We advocate for the creation of I4H at a MICs‐oriented financing institution such as the New Development Bank. We intend I4H to spark new thinking around innovative health financing approaches to ensure that the “golden age” of global health remains ahead.

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

Cited by 17 publications

References 30 publications

Aligning Funding and Need for Family Planning: A Diagnostic Methodology

Aligning Funding and Need for Family Planning: A Diagnostic Methodology

Evolution and patterns of global health financing 1995–2014: development assistance for health, and government, prepaid private, and out-of-pocket health spending in 184 countries

A New Golden Age? Proposal for an Innovative Global Health Funding Mechanism for Middle‐Income Countries

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