Less Buck for the Bang? The Flattening of Global Health Funding
The availability of funding for global health may well decide to what extent the health workforce will be able to meet countries' health care needs. With current financial uncertainties, the questions on our minds are: Will a decrease in global aid force cuts in spending for human resources? Is the era of big funding for global health already over?
“No,” says Dr. Cristian Baeza, World Bank director for health, nutrition, and population. While this era may not be over yet, in a recent lecture, Dr. Baeza discussed changes that will exert pressure on the availability of global health financing.
Areas of concern
1. Although global development assistance for aid has not reduced, the growth rate has fallen from previous years.
2. Private financing available to nongovernmental organizations has reduced, as demonstrated in the Institute for Health Metrics and Evaluation's recent report.
3. Innovative financing instruments are dependent on donor governments and multilaterals. For example the International Finance Facility for Immunization and the Advanced Market Commitments rely on government and multilateral aid to generate frontloaded funds for vaccine development.
4. Governments in developing countries are substituting donor aid for their own contributions toward the health sector, instead of using aid to supplement government contributions.
The audience was curious about changes in the prioritization of global health-related aid toward a larger focus on health systems and results-based financing. To me, this presented a paradox, so I asked Dr. Baeza, “If the world is looking to spend more on health systems strengthening and on evidence-based financing, wouldn’t the fact that health systems strengthening is relatively resistant to robust evaluation indicators present a dilemma?”
Performance indicators
Dr. Baeza replied that the key was to look at health outcomes as the ultimate indicators of a health system's performance, and not—as in the 1990s—just at the health systems unto themselves. He concluded by saying that the world had made an encouraging move in this right direction, and health outcomes are now widely accepted as the gold standard for health systems success.
Although global aid funding will not disappear, nonprofit and cooperating agencies must be alert to the trends and signals from the donor community. It is by maintaining this state of flexibility that organizations will be well-prepared to adapt to the shifting sands of global development aid.
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Photo 1 by Jennifer Solomon. Photo 2 by Trevor Snapp (Escuintla Hospital, Guatemala)
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