Dagi Kimani
6 July 2009
Nairobi — Two studies on donor health funding for regions like East Africa recently reached the same controversial conclusion -- that aid money often does not go to the right countries and diseases, and in some cases serves to weaken public health systems.
The studies, whose findings were published recently in the medical journal Lancet, were among others designed to establish whether health funding was having a significant positive impact on health outcomes in recipient countries.
In one of the reports appearing in the medical journal, World Health Organisation researchers concluded that "although global health funding initiatives (GHIs) had benefited millions, there was evidence that they had also held back the health systems of poor countries."
GHIs include such organisations as the Global Fund to Fight Aids, Tuberculosis and Malaria, otherwise known simply as the Global Fund, and the Global Alliance for Vaccines and Immunization (GAVI).
According to the WHO report there is significant evidence, for example, that donor-supported programmes for such diseases as HIV/Aids and malaria had drawn health workers from public health sectors with better pay and working conditions, thus weakening the very systems they were supposed to support.
"Services not targeted by GHIs are sometimes left behind and aid from outside could lead to countries reducing their own health spending," notes the WHO report. "(Donor-funded) programmes have achieved much and must continue, but they need to include targets for strengthening the general health systems of the countries where they are working."
Annual global health aid spending has risen from $5.6 billion in 1990 to $21.8 billion in 2007 -- nearly 300 per cent in 17 years. Most of the aid has gone to support programmes in a few specific areas.
The Global Fund, which was created in 2002, and GAVI, set up in 2000, are for example thought to have handled more than 12 per cent of all health assistance aid in 2007.
In May, several NGOs warned that this over-concentration of funding to a few diseases was overlooking interventions that could dramatically lower child mortality, such as funding against diarrhoeal diseases.
The second Lancet article seems to agree, noting that "the distribution of those extra dollars, euros and yen have disproportionately favoured nations whose health needs are not among the world's most urgent."
Giving the examples of Kenya and Bangladesh, the authors of the report say that between 2002 and 2007, the former received $1.2 billion in health aid while the populous Asian nation got $1 billion, despite having the seventh highest burden of disease.
Kenya, in contrast, has the 20th highest disease burden. Some poor countries with the same burden of disease were found to have differentials in health funding in the range of over 30 times.
According to health analysts, the distortions in health funding underline the fact that aid is a factor of many variables, including political stability, perception, and relationships between donor and recipient.
What's more, without a central, international database, donors often duplicate programmes in poor countries, leading to over-concentration of aid in one and under-funding in another.
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