How will global health financing change post-MDGs?

Hundreds of billions of dollars have been spent since 2000 to tackle some of the world’s biggest health problems. The bulk of global health financing was spent on efforts to curb the spread of HIV and make treatment for the virus accessible to everyone who needs it. From $1.4 billion at the start of the Millennium Development Goals, spending on HIV and AIDS shot up to more than $10 billion annually from 2010 to the present, peaking at $11.14 billion in 2013, according to the latest global health financing data released by the Institute for Health Metrics and Evaluation. Reducing under-5 mortality came in second. While nowhere near the levels spent on HIV and AIDS, funding to decrease child deaths has grown 8.3 percent annually since 2000. Spending to improve maternal health also grew, though pales in comparison at just $3 billion in 2014. The increases in spending for these three health problems are largely due to the MDGs, which brought the world’s attention to these global challenges — and the reason why advocates of neglected health issues are pushing for these concerns to be included in the post-2015 agenda. But as the MDGs come to a close, will funding for these three also wind down? Wider set of health goals The recently released post-2015 zero draft points to a wider health objective: universal health coverage. And while AIDS, under-5 mortality and maternal health continue to figure under the proposed Goal 3, they now share the space with other health issues, some of which have been gaining attention in recent years. The “epidemics of AIDS” for example is no longer a stand-alone goal, but rather bundled with tuberculosis, malaria, neglected tropical diseases, hepatitis, waterborne diseases and other communicable diseases. Emphasis has also been placed on noncommunicable diseases, which for long have received the smallest share of attention and development health assistance despite its global burden. In 2014, aid spending on NCDs was at $611.20 million or just 1.7 percent of the $35.9 billion in total health assistance. The inclusion of these diseases means the world’s attention will now likely be spread across a wider set of health challenges, which some consider a win compared with the MDGs’ narrow focus. But there is no guarantee that funding will indeed be more equitably or widely dispersed, especially since overall global health aid spending has plateaued at about $35 billion over the past four years. While donors such as the Bill & Melinda Gates Foundation and the United Kingdom continue to boost their health aid spending, several bilateral donors began reducing theirs in 2010. The United States, the biggest bilateral donor on health, has also seen its funding fluctuate in the past five years. Meanwhile, despite being covered by the MDGs on health, malaria and tuberculosis have seen limited funding and inconsistent growth in aid levels. Spending for malaria reached $2.29 billion in 2010, only to drop to $1.9 billion the following year. It picked up again in 2012, but has grown only 1.92 percent since. After peaking at $1.5 billion in 2013, TB spending levels also went down to $1.37 billion in 2014. Threats What is clear though is that stagnation in health aid spending presents real dangers for the least-developed countries, many of which continue to rely on external aid for their health needs. In sub-Saharan Africa, for example, which receives the biggest share of health aid spending, development assistance for health continues to outpace domestic resources. Such disparities are most notable in Uganda, Tanzania, Kenya, Ethiopia, Mozambique and Malawi, where the difference between government health spending and donor assistance number in hundreds of million. In Kenya, government spending for health tops out at $480 million. While certainly a significant sum, it pales in comparison to the $1 billion in foreign assistance it received in 2012, the latest year for which a breakdown in health spending is available in IHME’s data visualization hub. And these are the countries where foreign aid spending on HIV and AIDS are the highest among low-income economies. In Kenya, for instance, spending on HIV and AIDs constitutes 71 percent of the country’s total development assistance for health; in Rwanda, it accounts for 63 percent. Another problem relates to donor diversity, although this is more of an issue for efforts to curb the further spread of HIV and AIDS. The bulk of spending for this — or 62 percent of the $11 billion it received in 2014 — came from the United States alone. The report does note that domestic financing for health has been growing. About half of the available resources for HIV and AIDS in 2012, for instance, came from domestic resources, according to UNAIDS. This holds true particularly in middle-income countries in sub-Saharan Africa — such as Angola, Ghana, Nigeria and South Africa — where domestic health spending is in the billions. To read additional content on global health, go to Focus On: Global Health in partnership with Johnson & Johnson.