Working Papers

Where Have All the Donors Gone? Scarce Donor Funding for Non-Communicable Diseases Working Paper 228

11/1/10
Rachel Nugent and Andrea B. Feigl
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Health conditions in developing countries are becoming more like those in developed countries, with non-communicable diseases(NCDs) predominating and infectious diseases declining. The increased awareness of changing health needs, however, has nottranslated into significant shifts in resources or policy-level attention from international donors or governments in affected countries.Driven by changes in lifestyle related to nutrition, physical activity, and smoking, the surging burden of NCDs in poor countriesportends painful choices, particularly for countries with weak health systems that are struggling to manage persistent infectiousdisease burdens and to protect the poor from excessive out-of-pocket expenses.

Global development assistance for health (DAH) was estimated at $21.8 billion in 2007 (Ravishankar et al., 2009). A recentassessment shows that official development assistance for health reached $26.4 billion in 2008, surpassing all prior years (Kates etal., 2010). No specific mention is made of DAH for NCDs in developing countries in either study. This paper aims to fill that gap.We conducted an analysis of donor spending on NCDs in developing countries from 2001 to 2008 that reveals that less than3 percent ($503 million out of $22 billion) of overall DAH was dedicated to NCDs in 2007. The amount of donor assistance forhealth rose to $686 million in 2008. In terms of the burden of disease, donors provided about $0.78/DALY attributable to NCDsin developing countries in 2007, compared to $23.9/DALY attributable to HIV, TB, and malaria. If donors provided just half thesupport to avoid NCD DALYs that they provide to the three infectious diseases, it would amount to almost $4 billion in DAH forNCDs.

The picture of donor involvement in NCDs is not entirely bleak. Donor funding to developing countries for NCDs grew by618 percent between 2001 and 2008, with the largest increase coming from private, non-profit donors, and evidence of acceleratinginterest from bilateral donors. Multilateral organizations remain the largest category of funders. Nonetheless, additional donorfunding is needed to support developing-country efforts to incorporate NCDs into their existing health care programs through suchmechanisms as hypertension and cancer screening and prevention programs, and proven policy solutions such as tobacco taxationand salt reduction.

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