Global health funding: 2001-2011 and beyond

By Mark Harrington Treatment Action Group 27 October 2011 Lille, France

Global health funding has increased in recent years.

. The global health funding architecture has become much more complex

McCoy D et al. Health Policy Plan. 2009;24:407-417

Global health commitments are larger than disbursements

Health Official Development Assistance (ODA) Commitments by Donor, 2001 & 2008
US$ Billions 2001 2008

Total = $7.6 billion

Total = $26.4 billion

Notes: Amounts in gross US$ commitments. Health ODA combines data from four OECD CRS sub-sectors: (1) Health; (2) Population Policies/Programs and Reproductive Health (includes HIV/AIDS & STDs); (3) Water Supply/Sanitation; and (4) Other Social Infrastructure and Services - Social Mitigation of HIV/AIDS. Source: Analysis of data obtained via online query of the OECD Development Assistance Committee (DAC) Database and Creditor Reporting System (CRS), June 22, 2010.

Health Official Development Assistance (ODA) Commitments by Donor, 2001 & 2008
US$ Billions 2001 2008

Total = $7.6 billion

Total = $26.4 billion

Notes: Amounts in gross US$ commitments. Health ODA combines data from four OECD CRS sub-sectors: (1) Health; (2) Population Policies/Programs and Reproductive Health (includes HIV/AIDS & STDs); (3) Water Supply/Sanitation; and (4) Other Social Infrastructure and Services - Social Mitigation of HIV/AIDS. Source: Analysis of data obtained via online query of the OECD Development Assistance Committee (DAC) Database and Creditor Reporting System (CRS), June 22, 2010.

U.S. Global Health Initiative (GHI) as a Share of the Federal Budget, FY 2012*

Federal Budget $3.7 trillion

Global Health Initiative (GHI) $9.8 billion <1%

*FY 2012 is President’s Budget Request to Congress. Sources: Kaiser Family Foundation analysis of data from the Office of Management and Budget, Agency Congressional Budget Justifications, and Congressional Appropriations Bills.

The U.S. Government’s Global Health Architecture The White House
USAID
Bureaus for: Global Health; Economic Growth, Agriculture & Trade; Democracy, Conflict, Humanitarian Assistance. Missions

OGAC OES Ambassadors

State

HHS
OGHA OPHS

GHI
PMI
Defense USDA Treasury MCC EPA Peace Corps

CDC NIH FDA

NTD Program
PEPFAR

C O N G R E S S
Department

HRSA

Water for Poor

Homeland Security
Labor Commerce

K E Y

Independent Agency Dept. Operating Unit Multi-Agency Initiative

Notes: GHI: Global Health Initiative; PEPFAR: President’s Emergency Plan for AIDS Relief; PMI: President’s Malaria Initiative; NTD: Neglected Tropical Diseases Initiative; MCC: Millennium Challenge Corporation; OGHA: Office of Global Health Affairs; OPHS: Office of Public Health and Science. Source: Kaiser Family Foundation, The U.S. Government’s Global Health Policy Architecture: Structure, Programs, and Funding; April 2009; White House, Statement by the President on Global Health Initiative, May 5, 2009.

U.S. Global Health Initiative (GHI) & Other U.S. Global Health Funding, FY 2004-FY 2011
In Billions
Other Global Health GHI Programs

$9.8

$10.3

$10.8

$10.7

$2.3
$7.3 $6.3 $5.2 $4.4

$1.9

$1.8

$1.8

$1.4 $8.9 $8.9

$1.8 $5.9 $7.5 $8.4

$1.1 $3.3

$1.5 $4.5

$3.7

FY 2004

FY 2005

FY 2006

FY 2007

FY 2008

FY 2009

FY 2010

FY 2011 CR

*FY 2011 is currently funded through a Continuing Resolution (CR) that provides funding at FY 2010 enacted levels. Amounts are rounded. Note: The GHI was created as an initiative in FY 2009. All prior years represent the same programs and accounts which were not yet referred to as the GHI. Sources: Kaiser Family Foundation analysis of data from the Office of Management and Budget, Agency Congressional Budget Justifications prepared by individual agencies, and Congressional Appropriations Bills.

U.S. Global Health Initiative (GHI) Funding: Global HIV, FY 2001-FY 2012*
In Millions

*FY 2011 is currently funded through a Continuing Resolution (CR) that provides funding at FY 2010 enacted levels. FY 2012 is President’s Budget Request to Congress. Note: The GHI was created as an initiative in FY 2009. All prior years represent the same programs and accounts which were not yet referred to as the GHI. Sources: Kaiser Family Foundation analysis of data from the Office of Management and Budget, Agency Congressional Budget Justifications, and Congressional Appropriations Bills.

Top 10 Countries, U.S. Global Health Initiative (GHI) HIV/AIDS Funding, by Total FY 2010 Funding
In Thousands

* = GHI Plus Country
Source: Kaiser Family Foundation. The U.S. Global Health Initiative: A Country Analysis; February 2011.

U.S. Global Health Initiative (GHI) Funding: Global Tuberculosis (TB), FY 2001-FY 2012*
In Millions

*FY 2011 is currently funded through a Continuing Resolution (CR) that provides funding at FY 2010 enacted levels. FY 2012 is President’s Budget Request to Congress. Note: The GHI was created as an initiative in FY 2009. All prior years represent the same programs and accounts which were not yet referred to as the GHI. Sources: Kaiser Family Foundation analysis of data from the Office of Management and Budget, Agency Congressional Budget Justifications, and Congressional Appropriations Bills.

U.S. Global Health Initiative (GHI) Tuberculosis (TB) Countries, FY 2010

Source: Kaiser Family Foundation. The U.S. Global Health Initiative: A Country Analysis; February 2011.

Results (HIV)
• • • • Global ART programs cost $14-2-$16.6 billion over the past decade. Over the decade, ART for the 3.5 million patient initial cohort saves 18.5 million life-years. The corresponding gross discounted economic benefits amount to $34.0 billion. The monetary benefits range from 81 percent to 287 percent of program costs over the same period. These results suggest that, in addition to the large health gains generated, the economic benefits of treatment will substantially offset, and likely exceed, program costs within 10 years of investment.

- S Resch et al.(2011) Economic Returns to Investment in AIDS Treatment in Low and Middle Income Countries. PLoS ONE 6(10): e25310. doi:10.1371/journal.pone.0025310.

Recommendations
• Examine not only how much is raised but how it is spent and who benefits. • Create systematic global measurement systems for global health investments, disbursements, and impact. • Strengthen the ability of civil society to serve as a watchdog on how governments, NGOs, the private sector, and donor programs function to the benefit of the end-users and their communities.

References
McCoy D, Chand S, Sridhar D. Global health funding: how much, where it comes from and where it goes. Health Policy & Planning. November 2009: 24 (6): 407417. doi: 10.1093/heapol/czp026. Published online: July 1, 2009. Kaiser Family Foundation. U.S. Global Health Policy. 2011. globalhealth.kff.org/. OECD. Measuring aid to health. 2008. www.oecd.org/dac/stats/health. Resch S, Korenromp E, Stover J, Blakley M, Krubiner C, Thorien K, Hecht R, Atun R. (2011) Economic Returns to Investment in AIDS Treatment in Low and Middle Income Countries. PLoS ONE 6(10): e25310. doi:10.1371/journal.pone.0025310.

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