Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine Health Policy

cy and Planning 2012;27:527–534

ß The Author 2011; all rights reserved. Advance Access publication 8 December 2011 doi:10.1093/heapol/czr076

How to do (or not to do) . . . Tracking data on

development assistance for health
Karen A Grépin,1* Katherine Leach-Kemon,2 Matthew Schneider3 and Devi Sridhar4
1
Assistant Professor of Global Health Policy, New York University Robert F Wagner Graduate School of Public Service, New York,
United States, 2Data Development Manager, Institute for Health Metrics and Evaluation, University of Washington, Seattle, United States,
3
Post-Bachelor Fellow, Institute for Health Metrics and Evaluation, University of Washington, Seattle, United States and 4University
Lecturer in Global Health Politics, Department of Public Health, Oxford University, Oxford, United Kingdom
*Corresponding author. NYU Robert F Wagner Graduate School of Public Service, 295 Lafayette Street, 3rd Floor, New York, NY 10012-9604,
USA. Tel: þ1-212-998-7428. Fax: þ1-212-995-4162. E-mail: karen.grepin@nyu.edu

Accepted 23 September 2011

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Development assistance for health (DAH) has increased substantially in recent
years and is seen as important to the improvement of health and health systems
in developing countries. As a result, there has been increasing interest in
tracking and understanding these resource flows from the global health
community. A number of datasets, each with its own strengths and weaknesses,
are available to track DAH. In this article we review the available datasets on
DAH and summarize the strengths and weaknesses of each of these datasets to
help researchers make the best choice of which to use to inform their analysis.
Finally, we also provide recommendations about how each of these datasets
could be improved.
Keywords Development assistance for health, global health data, foreign aid, bilateral
donors, multilateral donors, Global Fund, GAVI

KEY MESSAGES
 The provision of development assistance for health (DAH) is important to the improvement of health and health systems
in developing countries, and has increased substantially. Interest in tracking and understanding these resource flows
from the global health community has likewise increased.

 This review provides an overview of the strengths and weaknesses of the datasets available to track DAH, in order to help
users decide which dataset is best suited for their analysis.

Introduction
Development assistance for health (DAH) has increased sub-
stantially in recent years.1 According to the Organisation
for Economic Co-operation and Development’s (OECD)
Creditor Reporting System (CRS), total DAH commitments
have increased from $6.6 billion in 2000 to $19.9 billion in
2009.2 These resources have not only increased in absolute
amount but have also increased relative to the gross domestic
product of recipient countries (Lu et al. 2010). These increases
have been driven by larger commitments from both traditional
donors and from new donors, such as the Bill & Melinda Gates
Foundation (BMGF) (McCoy et al. 2009).
Over the past decade, the global health community has
shown greater interest in understanding general trends in DAH
(Ravishankar et al. 2009; Murray et al. 2011; Stuckler et al.
2011), how DAH has been allocated among different health
priorities (Greco et al. 2008; Shiffman 2008; Sridhar and Batniji
2008; Liese and Schubert 2009; Patel et al. 2009; Piva and Dodd
2009; Ravishankar et al. 2009; Schaferhoff et al. 2010), the
allocations of DAH made by particular donors (McCoy et al.
2009), and the impact of these resources on health outcomes
(Mishra and Newhouse 2009). There has also been an increase
in the availability of DAH statistics; in the past few years alone
two major new datasets have been developed to provide data on
DAH. Those interested in conducting research on DAH now

527
528 HEALTH POLICY AND PLANNING
have a choice between datasets on DAH. Since each of these
datasets has been developed for a different purpose, for
a different audience and using a different approach, one
dataset might be better suited than another for a particular
type of analysis.
The purpose of the following article is to provide an overview
of the data sources currently available to track DAH. We
summarize the features of the main datasets, including the
kind of DAH tracked, the donors and recipients included,
the years for which the data were available and types of outlays
included. We discuss the strengths and limitations of each
dataset and describe how to access the data. Table 1 provides a
summary of the main features and information of each dataset
included in this review. In addition, we provide recommenda-
tions about how data collection efforts could be improved.
DAH datasets
OECD-DAC
The most commonly used source of information on DAH comes
from the OECD Development Assistance Committee (DAC),
which collects on an ongoing basis data on aid and other
resource flows to developing countries from member institu-
tions, some multilateral organizations, and other donors.3 These
data feed into two databases: the DAC annual aggregate
statistics, which provide data on aid flows broken down by
either donor, geographic region, type of aid, or sector; and the
CRS aid activity database, which provides project-level data,
including descriptive data of the projects when provided by
donors, which can be more flexibly manipulated by users. DAC
members report annually to the DAC secretariat official
development assistance (ODA), other official flows (OOF) and
private funding (foreign direct investment, bank and non-bank
flows) to developing countries. The DAC secretariat is
responsible for processing and disseminating the data.
The aid component of these flows is known as ODA, which is
defined as grants, technical assistance or concessional loans
given by official donors to developing countries for the purpose
of improving welfare or promoting economic development
(OECD-DAC, no date, a). The CRS reports ODA and OOF,
while the aggregate data also contain additional aid flows
(OECD-DAC, no date, b). To avoid double counting, the CRS
only reports the bilateral contributions of donors and not their
contributions to the regular budgets of multilateral institutions;
however, data on these contributions can be obtained in the
aggregate DAC statistics. For example, Canada may provide
bilateral funding directly to the government of Mali and some
of the funds it contributes to the World Bank’s regular budget
may also be used to finance health projects in Mali. The CRS
would only attribute the former and not the latter as aid
flowing from Canada to Mali.4 Expenditures from the regular
budgets of multilateral institutions are counted as multilateral
aid in the CRS database.
There are many advantages to using the OECD-DAC data-
bases. First, they are the most comprehensive source of data on
development assistance in general and therefore can be used to
make comparisons across sectors. The DAC has been collecting
data since 1967 and therefore provides the longest times series
of any dataset. In addition, the DAC uses standard reporting
procedures across a range of donors, thereby collecting com-
parable data from a diverse set of donors. Finally, the OECD
provides the data freely on its website which can be easily
downloaded in a number of formats (http://www.oecd.org/dac/
stats/idsonline).
There are also a number of limitations to using the DAC
datasets. While the completeness of data reporting to the DAC
has improved over the years, the comprehensiveness of the CRS
data varies overtime and was not considered sufficiently
comprehensive until recently.5 Furthermore, since only bilateral
contributions of donor countries are reported in the CRS, it is
not possible to account for all resource contributions from an
individual donor country using the CRS alone. Plus, the CRS
mainly only collects data from DAC members, so it only
captures limited data from select global health initiatives and
non-DAC bilateral donors and does not capture data from
non-governmental organizations (NGOs) or foundations, with
the exception of data from BMGF which began reporting data
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to the DAC in 2009, and can be downloaded from the CRS
online in the file containing data on Other Official Flows and
Private Grants.6
AidData/PLAID dataset
Designed to address some of the limitations of the CRS dataset,
the Project-Level Aid (PLAID) dataset was developed by
researchers at the College of William and Mary and Brigham
Young University in the United States (US). It has built on the
CRS dataset by including data from more non-DAC bilateral
and other donors, collecting data directly from multilateral
donors, standardizing some problematic variables, improving
project-level data descriptions and increasing the accessibility of
the data via a more user-friendly interface. In 2010, PLAID
partnered with Development Gateway to become known as
AidData. AidData tracks ODA plus additional aid flows, such as
market-rate loans, but like CRS it currently only tracks aid
flows from official aid agencies.7
A major advantage of AidData over CRS is that it includes
more data from non-DAC bilateral donors, as well as additional
multilateral and inter-governmental organizations.8 Data from
these agencies were collected from a number of sources, such as
annual reports, public websites or the statistical agencies of the
donors. While expanding the availability of data, this approach
has led to a less standardized data collection process across
donors than is used by the CRS, which uses the same data
collection procedure across all reporting agencies. In addition,
the approach of collecting data from multilateral donors directly
may have lead to some double counting of aid flows. Moreover,
the availability of historical data by donor varies greatly and
therefore aggregate estimates of aid flows will also be
influenced by the entry of new agencies into the dataset and
not just a change in funding commitments of previously
reporting agencies.
AidData has made efforts to recode traditionally problematic
CRS variables, such as country names and dollar amounts. The
development team has also developed a new coding scheme to
allocate aid flows to multiple sectors and purposes, if appro-
priate, thus enabling users to gain more insight into the use of
the aid flows. To construct such variables, however, the
developers had to manually inspect project descriptions and
Table 1 Main features of the development assistance for health (DAH) datasets reviewed

Dataset Dates available Types of outlays Included donors Included recipients Types of aid flows Suitable analyses
OECD Aggregate 1973 onwards, Commitments and DAC members, select non-DAC Developing countries or territories ODA, other official flows and Aggregate trends in DAH by
Aid Statistics annually disbursementsa donors, World Bank, Regional and multi-country recipients private funding by sector, recipient/donor/sector;
Development Banks, and some donor or recipient comparisons with other sectors/
UN agencies total aid
OECD CRS 1973 onwards, Commitments and DAC members, select non-DAC Developing countries or territories ODA by sector, donor Aggregate trends in DAH by
annually disbursementsa bilaterals, World Bank, Regional and multi-country recipients and/or recipient recipient/donor/sector;
Development Banks, BMGF comparisons with other sectors/
(2009-onwards), and some UN total aid; project descriptions
agencies
AidData/PLAID 1945 onwards,b Commitments or DAC members, select non-DAC Developing countries or territories Grants, loans and technical Aggregate trends in DAH;
annually disbursements bilaterals, World Bank, Regional and select middle-income assistance (in-kind or non-traditional donors; detailed
Development Banks, UN countries financial) project descriptions; comparisons
agencies, multilaterals, GAVI with other sectors/total aid
and GFATM
IHME’s DAH 1990 onwards, Estimated and National treasuries, corporations, World Bank (IBRD and IDA), IDB, Loans and grants (in-kind and Volume and sources of DAH
Database 2010 annually, preliminary debt repayments, US ADB, AfDB, DAC bilateral donors, financial) received by global health actors;
projections for disbursements foundations, other public and EC, GAVI, GFATM, UNAIDS, analysing trends in DAH over
recent years private donors, unspecified UNICEF, UNFPA, WHO, PAHO, time
donors US-based NGOs and foundations
IHME DAH 1990 onwards, Estimated World Bank (IBRD and IDA), Regions and countries Loans and grants (in-kind and DAH received by recipients over
Database annually disbursements AfDB, ADB, IDB, DAC bilateral financial); funding for HIV/ time; trends in DAH by 6 health
(Country donors, BMGF, EC, GAVI, AIDS, malaria, tuberculosis, focus areas; DAH by burden of
and Regional GFATM, UNFPA, UNICEF health sector support, disease
Recipient non-communicable diseases,
Level) 2010 and maternal, child and
neonatal health
GAVI data 2007-onwards Commitments and GAVI Alliance Recipient country governments, Grants (financial) Commitments and disbursements
reported to disbursements multilateral organizations, by recipient country, primary
OECD-CRS other recipients recipient and health focus area
GAVI financial 2005-onwards Total expenditure GAVI Alliance Unspecified Grants (in-kind and financial) Trends in commitments and
statements on accruals basis disbursements; administrative vs
programme expenses
GFATM 2002-onwards Disbursements GFATM Principal recipients by country Grants (financial) Commitments and disbursements
by recipient country, primary
recipient and health focus area
BMGF Online 1995-onwards Commitments BMGF Universities, research institutes, UN Grants (financial) Trends in commitments by
Grants agencies, World Bank, recipient, region and health focus
Database public–private partnerships, area; can be supplemented with
NGOs, foundations, governments, disbursement data from IRS-990
corporations PF forms
WHOSIS 1995-onwards Estimated Bilateral and multilateral donors; Governmental and Grants Researchers may want to consider
disbursements other external donors non-governmental sectors using more comprehensive,
(aggregated) (aggregated) detailed DAH databases
WHO’s National 1995-onwards Estimated Bilateral and multilateral donors; Governmental and Grants Researchers may want to consider
Health disbursements other external donors non-governmental sectors using more comprehensive,
Accounts (aggregated) (aggregated) detailed DAH databases

Notes:
a
While data on commitments and disbursements are available from 1973-onwards, the DAC only recommends using commitment data after 1996 and disbursement data after 2002.
b
The vast majority of projects in the AidData database range from 1973–2009, although data on a few select donors are available prior to 1973.
AfDB ¼ African Development Bank; AsDB ¼ Asian Development Bank; BMGF ¼ Bill & Melinda Gates Foundation; CRS ¼ Creditor Reporting System; DAC ¼ Development Assistance Committee; DAH ¼ development assistance
TRACKING DEVELOPMENT ASSISTANCE FOR HEALTH DATA

for health; EC ¼ European Commission; GAVI ¼ Global Alliance for Vaccines and Immunisation; GFATM ¼ Global Fund to Fight AIDS, Tuberculosis and Malaria; IADB ¼ Inter-American Development Bank;
IBRD ¼ International Bank for Reconstruction and Development; IDA ¼ International Development Association; IFFIm ¼ International Finance Facility for Immunisation; IHME ¼ Institute for Health Metrics and
Evaluation; NGO ¼ non-governmental organization; ODA ¼ official development assistance; OECD ¼ Organisation for Economic Co-operation and Development; PAHO ¼ Pan-American Health Organization; PF ¼ Private
529

Foundation; PLAID ¼ Project-Level Aid; UN ¼ United Nations; UNAIDS ¼ Joint United Nations Programme on HIV/AIDS; UNFPA ¼ United Nations Population Fund; UNICEF ¼ United Nations Children’s Fund; US ¼ United
States; WHO ¼ World Health Organization; WHOSIS ¼ World Health Organization Statistical Information System.

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530 HEALTH POLICY AND PLANNING
subjectively code the new variables, which might introduce
some errors. At the time of writing, these new codes had only
been introduced for a subset of the dataset. Finally, AidData
has had to make some assumptions about categorizing the CRS
data as a commitment or a disbursement, which may have led
to under-reporting of disbursements. AidData aims to provide
ongoing updates to their databases, however, it is not known
when additional releases will be made.
IHME DAH databases
The Institute for Health Metrics and Evaluation (IHME) has
developed its own DAH databases, which unlike the previous
databases discussed, were developed specifically to track health
projects (Institute for Health Metrics and Evalution 2010). To
compile their datasets, IHME begins with the data available in
the OECD databases and then complements with additional
data collected from reports, financial statements, online data-
bases, tax filings and other sources of information (Institute for
Health Metrics and Evalution 2010). IHME uses a broader
definition of aid that includes both ODA and non-ODA flows,
including aid provided through private donors such as select
NGOs and foundations as well as loans from IBRD. The IHME
databases, updated annually, primarily include flows channelled
through institutions whose main objective is the provision of
development assistance.10 There are two main databases:
(1) The IHME DAH Database (http://www.healthmetricsande
valuation.org/record/development-assistance-health-
database-1990-2008), which allows users to examine the
volume and sources of DAH received by different global
health actors, referred to as ‘channels of assistance’, and to
analyse trends in the volume of DAH disbursed by each
channel over time; and
(2) The IHME DAH Database (Country and Regional Recipient
Level) (http://www.healthmetricsandevaluation.org/record/
development-assistance-health-country-and-regional-
recipient-level-database-1990-2008), which can be used to
analyse DAH flowing from channels to countries and
regions over time and to assess trends in aid earmarked for
six health focus areas, HIV/AIDS; malaria; tuberculosis;
health sector support; non-communicable diseases; and
maternal, child and newborn health (Institute for Health
Metrics and Evalution 2010).
The IHME databases provide a number of advantages over the
other datasets. First, the databases contain estimated disburse-
ments from both public and private sources, including founda-
tions such as BMGF. Second, as with AidData, multilateral
donors are tracked using information obtained directly from the
donors instead of using the data from CRS, which is incomplete
for some multilateral donors (Ravishankar et al. 2009).
Disbursement data not included in the CRS, such as data
from GAVI prior to 2007, and the World Health Organization
(WHO) and Pan-American Health Organization (PAHO), are
also included. Third, IHME has carefully eliminated double-
counting among those channels that provided sufficient data
about sources of income and aid recipients.11 Finally, since there
is usually a delay of a year or two on development assistance
reporting, in addition to reporting actual disbursement data,
IHME also generates preliminary estimates (i.e. projections) of
DAH to provide more current estimates.12 The preliminary
estimates are based on data from bilateral, multilateral and
private channels including data from budgets, appropriations
and correspondence. These data should be interpreted more
cautiously than estimates based on actual disbursements.
Users should also keep in mind some of the limitations of the
IHME datasets. IHME used statistical models to impute certain
quantities in the dataset when faced with missing data, such as
DAH flowing through NGOs (Institute for Health Metrics and
Evalution 2010). Also, while the IHME DAH Database includes
DAH from many non-DAC bilateral donors, it only includes
their contributions to the European Commission, the World
Bank, UN Agencies and public–private partnerships that are
tracked through these institutions’ income statements, but
does not include direct transfers to developing countries.
Furthermore, in tracking private flows, IHME’s databases only
include DAH channelled through a subset of US-based NGOs
and foundations, as non-US NGOs and foundations are more
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difficult to track.13 Finally, while the IHME DAH Database
(Country and Regional Recipient Level) includes DAH estimates
for six health focus areas, the raw project descriptions are not
included in the databases, therefore it cannot be used to track
DAH to health focus areas beyond those reported on by IHME.
In future updates of its DAH research, IHME is working on
strategies to expand the scope of its databases and address
these limitations.
Donor-specific tracking mechanisms
Global Fund to Fight AIDS, Tuberculosis and Malaria
The Global Fund provides detailed information on approved
grants and disbursements against these grants on its website
(http://portfolio.theglobalfund.org/). For each approved grant
agreement, the Global Fund provides information on the
principal recipient, the target disease area, the amounts
disbursed and the date of disbursement. This information is
reported in Excel format, summaries of which can also be
obtained through the website. The data are updated as new
grant agreements are signed and as disbursements against
existing projects are made. However, the Global Fund does not
provide any information on how the resources are used by the
principal recipient, thereby limiting the usefulness of this data
for analysis.
GAVI Alliance
GAVI Alliance data are available in the OECD-DAC databases.
They provide detailed information on annual grant commit-
ments and disbursements, project descriptions, country focus
and primary recipient from 2007 onwards. GAVI’s financial
statements include annual expenditure data on an accruals
basis, which reflects expenditure when incurred instead of
actual disbursements, from 2005 onwards (GAVI Alliance,
no date; OECD-DAC, no date, c). For years prior to 2007,
researchers can obtain country-level disbursement data from
GAVI’s website (http://www.gavialliance.org/performance/dis-
bursements/index.php), but disbursement data comparable to
the GAVI disbursement data reported to the OECD-DAC are not
available on the GAVI website for these years. Users can obtain
GAVI’s disbursement data for missing years from IHME’s DAH
databases (Institute for Health Metrics and Evalution 2010).
 TRACKING DEVELOPMENT ASSISTANCE FOR HEALTH DATA
The OECD-DAC data allows users to analyse commitments
and disbursements by recipient country, primary recipient and
health focus area. Expenditure totals from GAVI’s financial
statements are useful for observing time trends and comparing
administrative vs programme expenses, but are not as detailed
as the OECD-DAC data.14
GAVI updates its data annually. While it has made significant
progress in transparency by reporting to the OECD-DAC, it
could further improve its aid reporting by providing commit-
ment and disbursement data for all years and all grants on
its website, as GFATM does.
Bill & Melinda Gates Foundation
BMGF is the first foundation to report to the OECD-DAC,
reporting 2009 data that have been included into the CRS
including information such as sector and purpose codes, project
descriptions, identification of primary recipient, and commit-
ments and disbursements. Also, BMGF’s online grant database
includes data on annual commitments for global health and
other sectors from 1995 onwards (http://www.gatesfoundation.
org/grants/Pages/search.aspx). Additional data include: name,
location and website of the primary aid recipient; project
description; terms of commitment; health focus area; and
region.
While BMGF provides more detailed grant disbursement
information than many other US foundations, users should be
aware of the online grant database’s limitations. Disbursement
data are missing, and details about recipient country or
countries are sometimes available in the project description,
but this level of detail is not systematically reported. Project-
level disbursement data are available in BMGF’s tax forms, but
these lack information on sector, region and health focus area
that is available in the online grants database (Bill & Melinda
Gates Foundation, no date; Guidestar, no date, a; Guidestar, no
date, b). Researchers can merge data from these two sources, as
IHME has done, but this process is arduous.15
BMGF’s online grant database is updated frequently, but it
does not publish notifications about updates to the database. To
analyse the data, users must copy and paste data into Excel,
which makes using the data time-consuming.
While BMGF provides useful DAH data, several improvements
could be made. It would be helpful if more years of data could
be included in the CRS. In its online database, the inclusion of
a variable denoting grant recipient country (when applicable) in
addition to reporting the region(s) to which grants are allocated
would be helpful. In addition, BMGF could set up a subscrip-
tion service to alert users to updates, include disbursement
information in the online grant database and allow users to
export data. Since the CRS data has a one year lag, the
availability of detailed disbursement data in BMGF’s online
grants database could give users more timely access to data.
World Bank
The World Bank provides on its website a Projects Portfolio
Search which allows users to search projects by recipient
country, sector, theme and goal as well as year of project
approval.16 The database is available from 1947 onwards and
allows users to specify a particular theme, such as human
development, as well as sub-themes (e.g. tuberculosis, malaria
531
and injuries). Users can also search by goal, which includes
health, communicable disease and health-related Millennium
Development Goals. This basic information, as well as amount
of commitment and year of approval, is provided in multiple
formats making it easy for users to manipulate the data.
Cumulative disbursement data are available upon exporting to
Excel. Upon clicking on individual projects, further information
is available such as the breakdown of the loan as well as the
name of the recipient in-country.
Given these features, the World Bank database has many
advantages for users looking for information on closed and
on-going projects. However, it has two major limitations. First,
data are provided cumulatively, not annually. The commitment
amount is provided only for the year of approval with details
on project duration, making it difficult to estimate yearly
disbursements. Second, the database does not provide any
information on World Bank Trust Funds, which have grown
from $95 million in 2003–04 to $2.4 billion in 2006–07, which
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is almost equal to the core funding, provided by the Inter-
national Bank for Reconstruction & Development (IBRD) and
International Development Association (IDA) ($2.8 billion). In
2009, health and social services received 42% of all Trust Fund
disbursements meaning that a large amount of finance is not
recorded in the project portfolio search (World Bank Group
et al. 2009).
The World Bank database could be improved by providing
yearly disbursements and by establishing a Trust Fund data-
base, similar to the Projects Portfolio database, to provide
information on the significant resources flowing through this
mechanism.
The Regional Development Banks
The Asian Development Bank (AsDB), the African Development
Bank (AfDB) and the Inter-American Development Bank (IDB)
have searchable project databases starting in the years 1968,
1991 and 1963, respectively, and up to the present.17 While all
three banks generate lists similar to the World Bank project
portfolio, this information is not exportable. In addition, limited
information on the amount of the project is only available
when clicking on each individual project. For the AsDB, for
further details on the project, such as project length and
cumulative disbursement information, users must go to a
different part of the website which has a detailed description of
the project in question. Complete information is only available
on the commitment amount, not on annual disbursements. In
contrast, the AfDB provides detailed information on the
description of the project, the objectives, the rationale and
benefits, and finally the estimated cost (i.e. commitment). It
also provides the name of the key contact for the project.
Disbursement data are available for closed projects only. The
IDB provides minimal project descriptions with cumulative
commitments and disbursements, not annual disbursements,
through the ‘Advanced Search’ on its website.
While the data provided by the Regional Development Banks
are perhaps useful for those looking for individual project
details, to move towards better accessibility and transparency,
these banks should consider developing a similar online
database to the World Bank that gives more detailed informa-
tion in an exportable format. All of these banks also report their
532 HEALTH POLICY AND PLANNING
data to the CRS and users may find that interface more useful
for extracting aggregate data from these donors.
USAID
The US produces an annual publication known as the
Greenbook, which provides data on the foreign aid loans and
grants authorized18 by the US Government every fiscal year
(http://www.usaid.gov/policy/greenbook.html). The data are
available from 1946 onwards and are organized by recipient
country and by programme area. Relevant to global health,
the data can be categorized by a number of programme areas
(e.g. the Global HIV/AIDS Initiative). However, if health
projects are covered by other programme areas, these funds
cannot be tracked using the Greenbook. The data reported in
the Greenbook differ in a number of ways from the ODA flows
reported to the OECD-DAC. Greenbook data are reported using
a different calendar year, they include military assistance and
contain reports on all countries that receive foreign aid from
the US. The Greenbook does not provide any information
about the primary recipient of each loan or grant in a given
recipient country.
Other relevant datasets
WHOSIS, housed in WHO’s Global Health Observatory (http://
www.who.int/gho/en/), provides data on external resources for
health as a percentage of total expenditure on health from
1995 onwards, while the WHO’s National Health Accounts
(NHA) include estimates of external resources for health from
1995 onwards (http://www.who.int/nha/en/). For some country
years, these datasets contain estimates from in-country reports
or NHAs. For other years, WHO relies on data sources such as
the OECD-DAC and data from other international funders such
as the Global Fund.19
These data have important limitations. First, these databases
neither disaggregate external resource data by donor, nor do
they provide descriptions about the primary recipient and
health focus areas of flows. Second, when WHO relies solely
upon OECD-DAC to estimate external resources, private flows
to countries are not captured, and flows from some global
health actors like GAVI are likely underestimated (Institute for
Health Metrics and Evalution 2010).
For additional information on US foundations providing DAH,
the Foundation Center provides tabular data on the foundations
giving the most international health grants from 2004 onwards,
and the total value of grants for international health since 2005
(http://foundationcenter.org/findfunders/statistics/listing02.
html). Total grants for international health are grouped into six
categories, including reproductive health care and mental
health. While helpful for understanding the overall amount of
DAH given by US foundations and information about total
contributions from a select number of foundations, these data
are highly aggregated. A publicly available database at the
individual grant level that contained variables such as founda-
tion name, grant amount, project descriptions, recipient name
and recipient country would allow users to better track the
geographical focus and purpose of DAH from US foundations.
Users in search of detailed information on DAH from
foundations can also go straight to the source of these funds.
In addition to BMGF, many foundations that provide large
amounts of DAH have online grant databases, such as the Doris
Duke Charitable Foundation, the Ford Foundation, the David &
Lucile Packard Foundation and the William and Flora Hewlett
Foundation.20 For more finely detailed information on founda-
tions’ international health grants, users can collect data directly
from these online resources if time permits.
Users seeking to find in-depth data on DAH from bilateral
donors can review detailed project data on the following
agencies’ websites: the UK’s Department for International
Development (DFID), the Canadian International Development
Agency (CIDA), the Swedish International Development
Cooperation Agency (SIDA) and the Agence Française de
Développement (AFD).21 These project databases provide infor-
mation such as project descriptions, details about primary
recipients and financial data. If using these databases,
researchers should be aware that they may not capture all of
the DAH provided by a bilateral donor during a given period of
interest. If comparing the data from these agencies’ databases
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to OECD-DAC data, users need to consider that the data may
not match due to differences in reporting standards.
Discussion and conclusion
The choices made in the design and construction of the various
datasets that are available to track DAH may make one dataset
more suitable to answer a particular question than another.
Our goal is to provide an overview of these datasets to allow
users to better understand the advantages and limitations of
the datasets and to help them determine which dataset is best
suited for their particular research question.
The CRS, AidData and IHME databases are all suitable for
estimating trends in DAH. However, if users are interested in
trends in ODA from the same set of donors over time, then the
CRS might be the best option. If users wish to also include
estimates of flows from non-DAC members, then AidData
might be the most useful. If users are also interested in trends
including select NGOs and foundations, when these data are
available, then the IHME datasets might be the most
appropriate.
The CRS and the AidData datasets also contain information
on development assistance flows to the non-health sectors, and
can provide estimates of total aid flows from particular donors
or to particular recipients. Therefore, these datasets are the
most appropriate to use when comparing DAH with other forms
of international financial flows.
If users are more interested in overall allocations to particular
disease areas, including funding that is channelled into
countries and regions, then the IHME databases might be
helpful. For other health areas, some disaggregation is also
available using the purpose codes contained in the CRS and the
AidData databases. If users are interested in aid flows from a
particular donor, then users might be advised to use data
directly from the donor.
No dataset is perfect. Users just need to understand the
strengths and weaknesses of each dataset before using them.
Furthermore, the authors encourage users to read the user
guides or manuals that accompany these datasets for more
details before using the data.
 TRACKING DEVELOPMENT ASSISTANCE FOR HEALTH DATA
We welcome the efforts of donors and other agencies to
increase the accessibility and transparency of DAH data.
However, more improvements can still be made. First, the
movement towards making data on DAH resource flows
available on the web should be encouraged. While availability
is the first step, accessibility, i.e. user friendliness, is equally
important; for example, by making data downloadable in
multiple formats. Second, donors should highlight when they
release new versions of data and make efforts to ensure that
users can easily incorporate newer updates into their analysis.
Third, for most donors there are significant differences between
the amounts they commit to a project in a given year and
how much they actually disburse, and therefore all donors
should report both commitments and disbursements.
Finally, donors should provide timely information, as the
Global Fund does, to enable researchers and decision-makers
to understand what is happening to health aid flows with
little delay.
A key step in improving the effectiveness of DAH is
understanding where money comes from and where it goes.
We hope this paper will be useful to a range of researchers,
policy makers, donors and aid recipients so that they can
choose the best data on which to base their DAH research.
Funding
None received.
Conflict of interest
KAG: none. KLK and MS participated in the development of
the IHME development assistance for health datasets discussed
in this manuscript. DS is a member of the IHME’s Financial
Flows Advisory Panel which advised the development of the
IHME DAH datasets.
Endnotes
1
DAH is generally defined as external resources, financial or in-kind,
that are channelled into a country from external sources to support
health-related activities. It generally includes funding for health
sector activities, as well as population programmes, but generally
does not include activities outside the health sector that may
impact health (e.g. water and sanitation programmes).
2 16
Calculated as the sum of commitments to purpose codes 120 (health),
130 (population) and 160.64 (social mitigation of HIV/AIDS) by
both bilateral and multilateral donors in the CRS database in 2009
constant US dollars.
3 17
As of 1 January 2010, OECD-DAC members included: Australia,
Austria, Belgium, Canada, Denmark, Finland, France, Germany,
Greece, Ireland, Italy, Japan, Korea, Luxemburg, Netherlands, New
Zealand, Norway, Portugal, Spain, Sweden, Switzerland, United
Kingdom, United States, and the Commission of the European
Communities. Korea only became a member of the OECD-DAC in
2010. The multilateral organizations that report to the DAC are
the World Bank, the African Development Bank, the Asian
Development Bank, the Inter-American Development Bank, the
International Fund for Agricultural Development, the United
Nations Children’s Fund, the Joint United Nations Programme
on HIV/AIDS, the United Nations Development Programme, the
United Nations Population Fund, the United Nations Economic
Commission for Europe, and the World Food Programme.
533
4
However, contributions from bilateral donors for projects executed by
multilateral institutions but that are not financed through regular
budgets (for example, Canada provides funding for a health system
project in Mali but executed by the World Bank) would be
included in the CRS under bilateral aid.
5
The DAC publishes coverage ratios for reported commitments and
disbursement data in the CRS database. In general, commitments
have higher coverage than disbursements. Users are encouraged to
analyse the coverage ratios for the data before undertaking any
analyses using the CRS data. As such, the DAC recommends not
using the CRS commitment data prior to 1995 or disbursement
data prior to 2002.
6
A number of non-DAC countries have begun to report their ODA
contributions to the DAC secretariat on a voluntary basis in
aggregate form; however, such data are not reported in the regular
DAC databases. A list of these non-DAC countries, as well as
aggregate aid data, can be obtained from the following website:
http://www.oecd.org/document/0,3343,en_2649_34447_41513218_
1_1_1_1,00.html.
7
In the future, it hopes to cover other forms of aid, such as those
originating from NGOs and foundations, but this information is
not yet available.
Downloaded from http://heapol.oxfordjournals.org/ by guest on August 17, 2015
8
The additional donors include the Economic and Social Commission
for Asia and the Pacific, the Economic and Social Commission
for Western Asia, the Food and Agriculture Organization, the
Fast Track Initiative, the World Trade Organization (WTO), the
WTO - International Trade Centre, Bulgaria, Czech Republic,
Czechoslovakia, Guadalupe, Hungary, Kosovo, Lebanon,
Lithuania, Martinique, Poland, Reunion, Romania, Russia, Serbia
and Montenegro, Slovakia, Saint Pierre and Miquelon, Iceland,
Liechtenstein, Monaco, Chile and Estonia.
9
The full list of NGOs included in the IHME DAH Database can
be downloaded from IHME’s Global Health Data Exchange
(GHDx): http://www.healthmetricsandevaluation.org/record/ihme-
formatted-usaid-volag-database-1990-2007. To view the list of
foundations included in this database, please refer to the
Foundation Center’s grants database: http://foundationcenter.org/.
10
See Financing Global Health 2010: Development Assistance and Country
Spending in Economic Uncertainty Methods Annex for details about
the methodology used to develop these databases: http://www
.healthmetricsandevaluation.org/sites/default/files/policy_
report/2010/financing_global_health_2010_methods_IHME.pdf.
11
IHME provides STATA code that allows users to eliminate
double-counting in the data provided in the IHME DAH Database.
12
Preliminary estimates of DAH are included in the DAH Estimates
Tables 1990–2010 and can be downloaded from IHME’s GHDx:
http://www.healthmetricsandevaluation.org/record/development-
assistance-health-estimates-1990-2010-tables.
13
IHME has not directly tracked NGOs and foundations based outside
the US due to data limitations.
14
Users should keep in mind that the GAVI data in the OECD-CRS and
financial statements are produced using different accounting
methods.
15
Alternatively, users can obtain BMGF disbursement data from
IHME’s databases.
http://web.worldbank.org/WBSITE/EXTERNAL/PROJECTS/0,,menu
PK:41389pagePK:95863piPK:95983tab:T1tgDetMenuPK:
228424tgProjDetPK:73230tgProjResPK:95917tgResMenuP-
K:224076theSitePK:40941,00.html
Asian Development Bank: http://www.adb.org/Projects/. African
Development Bank: http://www.afdb.org/en/projects-operations/
project-portfolio/. Inter-American Development Bank: http://www
.iadb.org/en/projects/projects,1229.html.
18
Actual disbursements, or outlays, are not recorded in the Greenbook.
19
The ‘Sources and Methods’ tab in NHA country pages contains
information on data sources that WHO has used to estimate
external resources for health.
20
Doris Duke Charitable Foundation: http://www.ddcf.org/Grants-
Awarded/. Ford Foundation: http://www.fordfoundation.org/
grants/search. David & Lucile Packard Foundation: http://www
.packard.org/searchGrants.aspx?RootCatID¼3&CategoryID¼226.
William and Flora Hewlett Foundation: http://www.hewlett.org/
grants/search.
534 HEALTH POLICY AND PLANNING
21
DFID: http://www.dfid.gov.uk/About-DFID/Finance-and-performance/
Project-information/. CIDA: http://les.acdi-cida.gc.ca/project-
browser. SIDA: http://openaid.se/. AFD: http://www.afd.fr/jahia/
Jahia/home/projets_afd/sante-health/pid/1335 (this website is
only available in French).
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