While aid for global public health programs skyrocketed just after the Millennium Development Goals (MDGs) were announced 15 years ago, aid has stalled in the past few years, according to a recent report by the University of Washington’s Institute for Health Metrics and Evaluation (IHME).
The MDGs, a set of eight anti-poverty goals with broad international backing, expire this year. Because of them, there have been significant reductions in child mortality and broad treatment of HIV/AIDS, malaria and tuberculosis in the developing world. However, donors must realize that continued funding is necessary to sustain the progress already achieved and make further improvements in public health internationally.
The report from the IHME found that there was an incredible surge in funding after the MDGs were announced, jumping from 5.4% prior to 2000 up to 11.4%. In the past 15 years, this growth in funding amounted to a total of around $228 billion invested in health-related causes. However, that growth has essentially stalled and, in some cases, reversed—from 2013 to 2014, total spending on health even decreased by 1.6%.
This trend can probably be attributed to waning enthusiasm for health-related aid once the initial excitement of the MDGs died down and their 2015 deadline draws to a close. Additionally, it could be a symptom of more cash-strapped governments seeking to trim their budgets after the 2008 global financial crisis.
While overall funding for health went down between 2013 and 2014, a few national donors did manage to increase their contributions, including the United Kingdom, Australia and Japan. Nongovernmental organizations also modestly increased their funding, including UNICEF, the Bill and Melinda Gates Foundation, and the African Development Bank.
Even modest changes in health aid funding would have a disproportionate impact on certain populations who have differing disease burdens. For example, 84% of funding for the treatment and prevention of HIV/AIDS comes from the United States. A small percentage decrease in funding for HIV/AIDS relief from the United States would have a much greater negative impact than a small percentage decrease from a smaller donor.
The IHME report, by describing flows of global health financing, reveals the need not only to maintain or increase aid but to diversify it also. Katie Leach-Kemon, a co-author of the study, said of HIV/AIDS funding that “diversifying the portfolio of financing sources for this area is crucial for safeguarding the progress made in combating the HIV epidemic.” Vulnerable populations would have access to more consistent aid if funding sources were spread more evenly across a wider variety of donors. That way, if funding trends continue to fluctuate, as they do in the report, those who typically rely on robust health aid programs, such as Ethiopia, Haiti and Kenya, will not find themselves cut off.
Health funding studies like the IHME report serve as excellent roadmaps that describe successes in global public health programs and reveal their shortcomings as well. Clearly, international initiatives with broad support, such as the MDGs, serve to jump start health aid. On the other hand, in the past five years, the incidence of tuberculosis was as high as 13% in some areas, HIV/AIDS as high as 20% and under-5 child mortality as high as 18%. Health aid has made huge strides in the past 15 years, but in order to continue reducing the global disease burden and improve the lives of people all over the world, funding has to be maintained.
– Derek Marion