Table below summarizes the trend in development assistance for health (DAH), among the main bilateral and multilateral agencies[6], the European Community, the Global Fund to fight AIDS, Malaria and Tuberculosis (GFATM) and grants provided by the Bill and Melinda gates Foundation (BMGF), which represent an estimated ninety percent of total DAH. Based on their annuals reports about commitments and disbursements for health in the lasts years, we can appreciate an increased by $ 1,7 billion –from $ 6,4 billion on average between 1997-1999 to $ 8,1 billion in 2002. Most of this increase was due to new funds committed by both public and private sources to the Global Fund to fight AIDS, Tuberculosis and Malaria.
DEVELOPMENT ASSISTANCE FOR HEALTH IN $ MILLIONS
1997 - 2002
Source: Catherine Michaud, MD, PhD. Development Assistance for Health (DAH): Recent trends and Resource allocation. Second Consultation Commission on Macroeconomics and Health. WHO 2003
Bilateral commitments for DAH increased only slightly over the past five years from 2,6 to 2,9 billion, UN agencies’ levels increased from 1,6 to 2 billion since 1997. The increase in the International Development Assistance (IDA) and IBRD commitments made by the World Bank during the 1990s has now stabilized around 1 billion per year. The Gates Foundation commitments increased rapidly since it was established in 1994 to $460 million on average between 1997 and 1999, and $600 million in 2002. Cumulative commitments since inception were equal to $3,6 billion by January 2004.
The distribution of DAH according to major sources indicate that it flows mainly through multilateral agencies which represent 53% and 57% of the total for the period 1997–1999 and year 2002 respectively. This increase of multilateral cooperation in 2002 is explained by the beginning of operations of the Global Fund to Fight against Tuberculosis, Malaria, and AIDS (FGTMS) during this year. In addition, there was an increase in the resources managed by the agencies specialized in health of the United Nations system of approximately $500 million between the years 1997 and 2002.
DEVELOPMENT ASSISTANCE FOR HEALTH
1997-1999 Average
2002
Source: Catherine Michaud, MD, PhD. Development Assistance for Health (DAH): Recent trends and Resource allocation. Second Consultation Commission on Macroeconomics and Health. WHO 2003
In 2002, the not-for profit private resources represented 7% of the entire. For instance, the Bill and Melinda Gates Foundation, from its beginning and until June 2004, devoted 3.8 billion dollars to health through direct support to the countries as well as through global and regional initiatives to fight and control disease. This represented 52% of all the grants (all sectors considered) provided by this foundation. The budget allocated to Health by this Foundation for the year 2003 is $ 979.2 million.
Overall, there has been a sustained annual average growth of DAH of 3.3% during the 1990s, a trend that continued until the year 2002, despite the downward trend in ODA witnessed until 2001. However, the DAH increase is still insufficient, if we consider that the Commission of Macroeconomics and Health has estimated at $ 27 billion the necessary amount of the DAH for 2007 and $38 billion for 2015 in order to finance the sustained improvement of the sanitary conditions of the poorer population [7].
During the period 1997–1999, the donor countries that contributed 80% of the entire DAH were the United States, Japan, United Kingdom, Germany, France, Netherlands and Australia. In 2002, Norway joined this group and the United Kingdom became the second largest donor in health, displacing Japan to the third place.
DEVELOPMENT ASSISTANCE FOR HEALTH
BILATERAL SOURCES
1997 - 2002
Source: Catherine Michaud, MD, PhD. Development Assistance for Health (DAH): Recent trends and Resource allocation. Second Consultation Commission on Macroeconomics and Health. WHO 2003
GEOGRAPHICAL DISTRIBUTION OF THE DAH:
In 2002, the geographic distribution of the DAH shows that Africa receives the highest proportion of this assistance (45%), followed by Latin America and the Caribbean with 17%. And within ALC, Central America and the Caribbean is the sub region that had received the highest proportion of DAH.
GRAPH 7: GEOGRAPHICAL DISTRIBUTION OF THE DAH IN THE WORLD
2002
Source: Catherine Michaud, MD, PhD. Development Assistance for Health (DAH): Recent trends and Resource allocation. Second Consultation Commission on Macroeconomics and Health. WHO 2003
GEOGRAPHICAL DISTRIBUTION OF THE DAH IN LAC
1991 - 2002
Source: OCDE’s database
The allocation of DAH has also experienced an important evolution in recent years, with an increase in the category of population (family planning, health reproductive and control of STI even HIV/AIDS) and basic health. In 2002, 45% of all the DAH went to the population category, while 37% went to basic health.
AID TO HEALTH BY SUB-SECTOR
1990 - 2003
Source: OECD’s Data base
Source: OECD’s Data base
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[5] Catherine Michaud, MD, PhD. Development Assistance for Health (DAH): Recent trends and Resource allocation. Second Consultation Commission on Macroeconomics and Health. WHO 2003
[6] WHO, UNICEF, World Bank, Inter American Development Bank, African Development Bank, African Develoopment Fund
[7] Jefrey Sachs. Macroeconomics and Health: Investing in Health for Economic Development. WHO 2001
[5] Catherine Michaud, MD, PhD. Development Assistance for Health (DAH): Recent trends and Resource allocation. Second Consultation Commission on Macroeconomics and Health. WHO 2003
[6] WHO, UNICEF, World Bank, Inter American Development Bank, African Development Bank, African Develoopment Fund
[7] Jefrey Sachs. Macroeconomics and Health: Investing in Health for Economic Development. WHO 2001
