The new breed of global health donors

Squeezed by austerity measures at home, traditional donor funding for global health has slowed considerably in the wake of the global financial crisis. After rising markedly in the 2000s, development assistance for health reached $31.3 billion in 2013 — up by just 1 percent from 2011. Amid signs that pressures on aid budgets are easing, U.S. and European donors are putting the onus on host governments to finance more of their own health needs. Case in point: The United States has set in motion plans to transition the financial and managerial burden for the U.S. President’s Emergency Plan for AIDS Relief — the single-largest global health program — to host governments. Undeterred by slowing growth, emerging donors seem to be moving in the opposite direction. While they are still massively outspent by U.S. and European donors, emerging donors, which include the BRIC economies, have been steadily increasing their funding and engagement in global health. Most recently, both China and India have pledged millions in contributions to the Ebola response. By most accounts, this new breed of global health donors is keen to leverage their own experiences in addressing domestic health challenges to foster health improvements elsewhere in the developing world. At the same time, they generally regard their global health engagement as a tool to advance their geopolitical interests — a view that is arguably shared in Washington and Brussels as well. Below, Devex analyzes the strategies and priorities of six of the largest and most prominent emerging global health donors. Strikingly, we found that most of these donors focus their assistance heavily on health infrastructure projects whose results are more visible on the ground. China By far the largest emerging donor, China directs the lion’s share of its global health assistance on Africa — a key element of its aggressive diplomatic and development strategy in the region. According to one widely cited study from the Peking University Institute for Global Health, China committed more than $757 million in health assistance to Africa between 2007 and 2011. The Chinese government’s second white paper on foreign aid, released in July, reaffirmed health as a focal sector of its $5 billion foreign aid program. Historically, China has delivered its global health assistance primarily through the dispatch of medical teams that provide free medical care in developing countries. Chinese medical teams accounted for nearly half of Beijing’s health assistance to Africa between 2007 and 2011. According to the Chinese government, it has deployed more than 20,000 medical workers to Africa over the past five decades, including at least 400 to West Africa since the Ebola outbreak this year. Over the past decade, however, China has steadily diversified its global health program, which now also includes large-scale investments in health infrastructure and human resources. In Africa alone, China has assisted in the construction of 30 hospitals and 30 malaria prevention and control centers, as well as trained more than 3,000 medical staff. Chinese health officials have hinted that they may soon refocus their engagement in Africa on strengthening the continent’s public health systems in response to the Ebola outbreak. Russia Drawing on its expertise from Soviet-era programs, Russia has re-emerged as a major global health donor over the past decade. In 2010, the Russian government reported $80 million in health assistance — a figure that has likely risen in the years since given the 29 percent increase in Russian aid spending over that period. Compared with its emerging donor counterparts, the Russian aid program has a particularly sharp focus on global health. Between 2006 and 2010, one-fourth of Russian aid spending was allocated to health. Until recently, Russian aid spending had been principally channeled through multilateral agencies — a trend that is unique among its BRIC peers. Since 2002, Moscow has poured $317 million in contributions to the Global Fund to Fight AIDS, Tuberculosis and Malaria. More recently, Russia committed $75 million to the Muskoka Initiative on Maternal, Newborn and Child Health, which was announced at the G-8 summit in 2010. Following the deterioration in Moscow’s relations with the West over Ukraine — Russia has been suspended from the G-8 — Russian officials have indicated that Moscow may now opt to channel its foreign assistance on an increasingly bilateral basis. Keen to beef up its strategic and political posture in its immediate neighborhood, Russia seems poised to bolster its modest health assistance in Central Asia, which currently focuses on infectious diseases and epidemic preparedness. Between 2006 and 2009, Russia had contributed $46 million to a regional capacity-building program designed to counter the threat of emerging diseases. (Stay tuned for our in-depth analysis of Russian foreign aid next month). Brazil While Brazilian health assistance is hard to quantify due to the lack of official figures or reliable estimates, reputable third-party assessments have confirmed the Brazilian aid program’s heavy emphasis on global health. In 2010, Brazil’s overall foreign aid spending reached $731 million, representing a staggering 91 percent increase from 2009. Health accounted for the second-largest share (16 percent) of Brazilian technical cooperation activities between 2003 and 2010. Brazil’s health cooperation largely focuses on Portuguese-speaking countries in Africa, as well as in parts of Latin America and the Caribbean. Drawing on its own successes in addressing domestic health challenges, the country’s health assistance has been deliberately geared toward technical cooperation activities in the fields of HIV and AIDS, nutrition and capacity development. Case in point: Brazil has leveraged its expertise and experience as the first developing country to produce antiretroviral drugs on a large scale to help Mozambique build sub-Saharan Africa’s first publicly owned antiretroviral factory. The facility, which opened in 2012, received a $23 million investment from the Brazilian government as well as technical assistance from the Oswaldo Cruz Foundation, the state-run health institute. Brazil has further distinguished itself from its peer donors through its leadership in the field of trilateral health cooperation. A recent Center for Strategic and International Studies report cited Brazil’s partnership with the German Agency for International Cooperation to combat HIV and AIDS in Uruguay as a model for trilateral health cooperation. India Heavily focused on its South Asian neighbors, India’s fledgling aid program has committed upward of $100 million in global health assistance since 2009. That figure is likely to increase under the new government of Prime Minister Narendra Modi, which hiked the Indian aid budget earlier this year by 34 percent over 2013 levels. India’s health assistance to Bhutan, Nepal, Sri Lanka and Afghanistan is mainly channeled toward health infrastructure projects, including the upgrade and construction of hospitals. Positioning itself for a more visible development presence in post-drawdown Afghanistan, India has rehabilitated the country’s only children’s hospital and built basic health clinics in 10 border provinces. Beyond South Asia, however, the Indian aid program’s limited health engagement is largely eclipsed by the massive Indian generics industry, which supplies 80 percent of donor-funded therapies around the world. New Delhi’s most prominent engagement in global health outside the Indian subcontinent is the $125 million Pan-African e-Network, a tele-education and telemedicine initiative that connects 47 African countries with schools and hospitals in India through satellite and fiber-optic links. South Korea The first former aid recipient to join the Development Assistance Committee of the Organization for Economic Cooperation and Development, the donor grouping for industrialized countries, South Korea recorded nearly $128 million in official development assistance for health in 2012 — an increase of a third since the country joined the donors’ club in 2009. That figure is likely to rise even further as South Korea strives to meet its goal of spending 0.25 percent of gross national income on ODA by 2015. South Korea’s global health priorities seem more diverse and multifaceted than its peer donors. According to the Korea International Cooperation Agency’s 2011-2015 health strategy, it will prioritize support for five subsectors: human resources, health regulations, health services, maternal and child health, and communicable diseases. KOICA is the South Korean government’s lead aid agency. In 2012, 55 percent of KOICA’s health ODA was channeled toward basic health infrastructure projects. Despite KOICA’s increasingly global ambitions, the bulk of the agency’s health assistance is directed to Asia-Pacific, the region which has historically been the largest recipient of Korean aid. In 2012, Vietnam and Afghanistan each garnered roughly a fifth of KOICA’s health ODA globally. Turkey Flexing its foreign aid muscle in the aftermath of the Arab Spring, Turkey reported $98 million in global health assistance in 2012, a 78 percent jump from the year before. The Turkish aid program implemented health projects in more than 15 countries and territories in 2012. Turkey’s most visible health interventions have been its construction and upgrading of health infrastructure in humanitarian hotspots, particularly Somalia, Sudan, Afghanistan and the Palestinian territories. Over the past year, Turkey has completed the construction of a $35 million, 400-bed training hospital in the Somali capital Mogadishu — the latest in a string of Turkish-built hospitals in Somalia. Adding a further dimension to Turkey’s global health footprint, Ankara has recently concluded technical cooperation agreements with a host of countries in Africa and Asia. In 2012, the Turkish Ministry of Health provided medical training to 443 physicians and health personnel from 14 countries. That same year, the ministry also deployed 149 physicians and health personnel overseas. Check out more practical business and development advice online, and subscribe to Money Matters to receive the latest contract award and shortlist announcements, and procurement and fundraising news.