Back in November 2011, Devex reported on some of the more significant realignments in global health funding from 2000 through 2010. That assessment yielded some interesting findings including the fact that both traditional aid donors and new global health actors boosted their commitment to the “Big 3” communicable diseases – HIV/AIDS, tuberculosis, and malaria – which are pillars of the Millennium Development Goals.
The targeted spending increases have produced results and saved millions of lives. An estimated 3.3 million people are on antiretroviral AIDS therapy. About 8.7 million have been cured of tuberculosis. To date, 240 million insecticide-treated bed nets have been distributed in the fight against malaria.
With the Millennium Development Goals target year of 2015 around the corner, global health spending on these focus areas has continued to rise, albeit at a much slower rate than previous years. According to the latest report from the Institute for Health Metrics and Evaluation, global health financing grew 4 percent annually from 2009 to 2011, reaching $27.7 billion last year.
But some events and trends appear threatening in the longer term. For instance, U.S. health giving increased by just 1.6 percent last year compared to an average 18 percent increase over the previous decade. Iceland, Italy, Portugal, and Spain have stopped contributing to the Global Fund to Fight AIDS, Tuberculosis, and Malaria.
Failing to meet its replenishment target, the Global Fund announced last November that it would not grant new funding for the “Big 3” of communicable diseases until 2014. Similarly, since July 2010, the World Health Organization cut more than 1,000 jobs worldwide and slashed $1 billion from its 2012-2013 $4.8 billion budget as the surge in the value of the Swiss franc swelled the organization’s costs and member nations tightened donations.
Though development assistance for health from some donors and channels has dropped, others showed encouraging signs of growth.
Some of the sources driving this growth: the United Kingdom increased its global health giving by 14 percent in 2011. At a fundraising conference last year, the Global Alliance for Vaccines and Immunization received funding commitments from donors amounting to $4.3 billion, exceeding its target of $3.7 billion. Private giving, spearheaded by the Bill & Melinda Gates Foundation, increased considerably from 2010 to 2011.
Whether or not gains continue to offset losses in the global money-go-round for health in the near future, many global health experts are predicting positive growth for 2012. Devex used the 4 percent growth figure and an analysis of health trends to make its own 2012 projections of global health spending by focus area. Rounding out the top six global health subsectors in addition to the “Big 3” are population and reproductive health, health systems, and noncommunicable diseases. These six focus areas account for approximately 78 percent of total global health spending.
Over the past decade, HIV/AIDS has been one of the top health priorities for global donors. Indicative of a shift away from targeting specific diseases and growing support for population and reproductive health, however, development assistance for HIV/AIDS dropped from $7.6 billion in 2009 to $6.9 billion in 2010. This 10 percent reduction was the first in more than a decade. Analysts point to decreased disbursements from Australia, Germany, the Netherlands, Norway, Spain, Sweden, and the United States as the reason behind the overall decline in global HIV/AIDS funding. U.S. contributions to the cause fell from $4.4 billion in 2009 to $3.7 billion in 2010 due to additional requirements placed by Congress in reauthorizing the U.S. President’s Emergency Plan for AIDS Relief.
In the face of these funding risks, the United Nations is leading the push to eradicate HIV/AIDS once and for all through an annual investment of $22 billion to 24 billion by 2015. Whether or not the U.N. will successfully mobilize funds beginning this year, the global health community can conservatively expect donor funding for HIV/AIDS in 2012 to likely remain at 2010 levels or an estimated $6.9 billion.
Population and reproductive health
Since 2009, development assistance for population and reproductive health remained steady at $10 billion. The largest portion of this funding was programmed for sexually transmitted diseases andHIV/AIDS prevention programs (68 percent), followed by basic reproductive health services (23 percent), family planning services (7 percent), and research and development policy analysis (2 percent).
Analysts contend that these allocations could change because maternal and child health, a subcategory of reproductive health services, has garnered significant policy attention due to its alignment with the health MDGs. Donor governments at the G-8 summit in Muskoka, Canada, promised to give $5.6 billion to the cause. Developed and developing country governments, as well as private donors pledged $40 billion for the next five years to save the lives of both mothers and their children. For now, however, based on projections made by the U.N. Population Fund, donor funding for population and reproductive health will increase slightly from $10.5 billion in 2010 to around $10.8 billion in 2012.
Last year, foreign aid funds committed to malaria control peaked at $2 billion. According to the IHME, development assistance for malaria exhibited stunning growth since 2007 due to large donations channeled through the Global Fund. For 2012-1014, international funding for malaria is expected to remain relatively stable at $2 billion before dropping to $1.5 billion in 2015. The projected drop in funding is due to reduced Global Fund commitments being offset by increased financing from the United Kingdom’s Department for International Development of up to $800 million by 2015.
Many countries — including France, Japan, Norway, the U.K., and the U.S. — have publicly recognized that realizing the health MDGs requires strengthening health systems: service delivery, health workforce, health information systems, access to essential medicines, financing, and governance. In fact, since 2005, health systems have consistently received increased funding from donors. In 2009, development assistance for health systems totaled $1.23 billion or 5 percent of overall global health spending. With renewed focus on aid effectiveness coming out of the conference in Busan, South Korea, 2012 funding is projected to increase to $1.36 billion.
IHME estimates show that funding for tuberculosis surpassed $1 billion in 2009, but have leveled off since then. Three quarters of funding for the fight against tuberculosis in the developing world come from domestic sources. In 2010, Brazil, the Russian Federation, India, China, and South Africa invested $2.1 billion on tuberculosis control. This year, health giving for tuberculosis is expected to increase to $1.12 billion, with $515 coming from the Global Fund and $600 million from international donors.
While noncommunicable diseases such as cancer, heart disease, and diabetes account for 45 percent of the overall disease burden in developing countries, development assistance for noncommunicable diseases averages only 1 percent of global health spending. In 2009, international financing amounted to $270 million. In 2012, this figure is expected to increase to $288 million. Recent efforts to generate worldwide attention for the cause, such as the 2011 U.N. High-Level Meeting on Noncommunicable Diseases may increase donor support. WHO also vowed to prioritize the issue this year. Raising funds for noncommunicable diseases can be difficult because the focus area generates less of a “human dignity pull” since one of its major causes is an unhealthy lifestyle.
Christine Dugay contributed to this report.