Major gains in global health spending over the last decade are over. This was the top line message from the 2012 edition of Financing Global Health, the fourth report in the series, which Chris Murray and Michael Hanlon of the Institute for Health Metrics and Evaluation recently presented at CGD.
Many currently believe that US domestic entitlements are too large, but disregard the fact that the PEPFAR program has created a new class of moral entitlements overseas – in the form of 4 million and counting people receiving US-supported life-sustaining AIDS treatment in low and middle income countries around the world. Of course, the approximately $2.7 billion that the US spent in 2011 (53% of the $5.3B 2011 budget) on supporting the treatment of these people is only about two-tenths of a per cent of the US’s annual expenditure on Socia
There’s an AIDS spending cliff in Ethiopia and the government is already in free fall. Next year, Ethiopia will experience a 79% reduction in US HIV financing from PEPFAR. The announcement of these cuts came with an explanation that PEPFAR was “free(ing) up resources by reducing programs in lower HIV prevalence countries” (see blog). Further, Global Fund monies have gone almost completely undisbursed in 2012. These cuts in spending might be warranted due to epidemiological trends and improved efficiency, or might cripple progress as health programs dependent on external donors are cut back. The truth is, with the current poor status of basic information on beneficiaries and costs, it’s difficult to judge whether these cuts are good or bad.
Video of the debate may be viewed here.
Yesterday was an exciting day for me. In a debate at the World Bank timed to coincide with the International AIDS Conference a colleague and I took an unpopular position against two development celebrities in front of a potentially hostile audience and changed some minds. The proposition was:
“Continued AIDS investment by donors and governments is a sound investment, even in a resource constrained environment”
Saving kids: Who doesn’t want to do that? Though relatively uncontroversial (say, compared to saving drug addicts and sex workers), the agenda for child survival is not new. In fact, it’s a (relatively) old agenda in global health, arguably dating back to the time of UNICEF's third Executive Director James Grant (1980-1995) who pushed to recognize the “global silent emergency” and to reduce preventable child deaths.
A few days ago the World Health Statistics 2012 Report released its annual compendium of statistics. No doubt, it was a lot of work to compile—to verify every number in every cell, for each country and indicator. The WHO should be commended for providing this invaluable global public good. A sincere request: the Report would be more user-friendly and useful if the Report came with spreadsheets in downloadable tables (much like the World Malaria Report), and if the Report’s tables were consistent with their main database, the Global Health Observatory (GHO). For example, the coverage measures of oral rehydration therapy (ORT) which were included in the Report are absent from the GHO, as far as we can tell. (On an unrelated note, we did notice that the GHO recently added hand-washing as an indicator, perhaps in response to a recent blog—kudos to WHO!)
Cash on Delivery Aid (COD Aid) is moving from concept to reality as I learned in a recent trip to Europe. In the process we are learning a lot about measuring outcomes and other implementation challenges. While I heard about the ways aid agencies are beginning to try COD Aid or similar initiatives, the internal resistance they face told me a lot about the internal contradictions we’ve lived with in foreign aid for a long time.
For many years, the G8 was a great place for global health. In 2010, the G8 committed to US$ 5 billion for maternal, newborn and child health that grew into the US$ 40 billion Global Strategy on Women’s and Children’s Health. In 2007, G8 members made a $1.5 billion pledge “to reduce the gaps in … maternal and child health care and voluntary family planning.” In 2005, leaders agreed to provide “universal access to anti-HIV drugs in Africa.” And in 2001, the G8 created the Global Fund on AIDS, Tuberculosis and Malaria.
One of the few things donors agreed on at the High Level Forum on Aid Effectiveness in Busan was the need for increased transparency: better aid data is needed to help donors channel their aid more effectively and recipient countries hold their donors accountable. Yet despite the shared commitment, data on aid flows remains incomplete, complicated and fragmented, particularly at the sector level.
The President’s budget request for 2013 is out: total money spent on GHI is reduced by 3.5% and PEPFAR’s budget shrinks by 10.8%. While both figures may be alarming, there is a bright spot: contributions to the Global Fund for AIDS, TB and Malaria go up by 27% to $1.65 billion. In addition to the Global Fund, GAVI, IDA, Asian Development Fund and the African Development Fund are all among agencies that are getting increases on their funding; notably, GAVI by 11.5%.