Total spending in global health

Summary

For a nice overview of the overall flow of health aid money, see the work out of the Institute for Health Metrics and Evaluation (IHME), which uses data from numerous sources including Development Assistance Committee and Common Reporting Standard databases; data from the WHO, World Bank, and Gates Foundation; and national aid data. See supplement to “Sources and Focus of Health Development Assistance, 1990–2014” and annex to “Financing Global Health 2015: Development assistance steady on the path to new Global Goals” for the full list. For 2015, this tracks around $40 billion in development assistance for health (DAH). Refer to the reports and papers for commentary and pre-computed visualizations, or to Viz Hub for an interactive web app.

For specific project-level information, see the IATI Registry, which keeps track of submissions that use the IATI format. My impression is that some of the sources used by IHME’s work also contain project-level information, but I haven’t investigated this.

Blind spots, interpretive cautions

The funding reports from IHME track the time period 1990–present. Funding data from specific foundations tend to begin sometime in the first decade of the 2000s or the 2010s.

At this point I don’t really know which donors, cause areas, and recipients might be missing; this is the sort of thing that becomes obvious when one tries to do something with the data that involves knowing the data about some org or cause area.

As far as I can tell, IHME’s analysis does not use data from IATI. I cannot tell whether this is because it obtained the same sort of data from other sources, didn’t have time to assess the quality of IATI’s data, or somehow didn’t like IATI (I’m assuming they have heard of it).

IATI data are published in a timely manner as far as I can tell (it depends on the publisher org, so the time lag cannot be stated in a concise way). IHME’s reports are published every two years or so, along with their other GBD work.

Notes

From some WHO report:

The subject of health expenditure is in itself a challenging topic. No exact measurement exists for the basic health expenditure in all countries. Even in countries with advanced statistical systems, some modifications are made periodically to estimated expenditure levels due to improvements in sources and methods. In spite of national efforts, not all relevant data are provided in the detail needed so estimations are still required. The GHED contains the best available estimations/data of the variables to date.

From another WHO report (page 2):

In 2011, US$ 6.9 trillion was spent on health. [By whom? The “Key facts” section doesn’t say]

Page 7 elaborates:

In 2011, the world spent a total of US$ 6.9 trillion on health at exchange rates or I$ 7.2 trillion (International dollars taking into account the purchasing power of different national currencies). The geographical distribution of financial resources for health is uneven. There is a 20/80 syndrome in which 34 OECD countries make up less than 20% of the world’s population but spend over 80% of the world’s resources on health.

From the same report (page 3):

Increasing external support
If all donor countries were to immediately honor their overseas development assistance pledges, more than three million lives would be saved by 2015.

I’m not sure what these pledges are and how much money they add up to, but finding that would yield one estimate of the cost per life saved.

Page 6:

Half to two-thirds of total government spending on health is used for hospital care.

Page 9, which indicates that the spending figure from 2011 might be quite a bit off, since health spending seems to change a lot in just a few years:

Trends between 2001–2005 show significant increases in total expenditures on health in the group of low-income countries. Taken as a group, these countries spent $11 (in 2005 US$) per capita health in 2001, a figure that includes contributions from external sources such as bilateral and multilateral partners and foundations. This had increased to $15 in 2005, and $21 in 2011. This represents an increase of 85% over the period.

WHO also has its own expenditures database thing.

Financing Global Health 2009: Tracking Development Assistance for Health:

Financing Global Health 2009 provides the most comprehensive picture available of the total amount of funding going to global health projects spanning two decades. It takes into account funding from aid agencies in 22 developed countries, multilateral institutions, and hundreds of nonprofit groups and charities. Prior to this report, nearly all private philanthropic giving for health was unaccounted for, meaning that nearly a third of all health aid was not tracked.

Dieleman et al. (2016, p2) describe the literature as follows:

Evidence before this study
Much research has sought to describe the disbursement of development assistance for health (DAH). Previous research articles and reports by the Institute for Health Metrics and Evaluation have tracked DAH from 1990 onward, disaggregating spending by the source of funding, intermediary channel, recipient country, and health focus area. Other studies have concentrated on specific health focus areas, such as the estimates produced by Countdown to 2015, which focused on maternal, child, and newborn health. In addition to resource tracking, separate, relatively contentious lines of research have aimed to measure the effectiveness of DAH, and the practice in which development assistance displaces government spending. These studies vary in scope and conclusion, with some focusing on cross-country longitudinal analyses, and others concentrating on a single country or programme. Finally, there is a substantial body of research that aims to connect governance and DAH, and explores how DAH is allocated across recipient countries and health focus areas. Conclusions from these studies have been quite mixed.

Page 5, § Results:

We used more than 60 data sources. Data were collected from the Organisation for Economic Co-operation and Development (OECD)’s Creditor Reporting System (CRS); the OECD’s Development Assistance Committee (DAC); project-level data from the Gates Foundation, the Global Fund, Gavi, and the World Bank; grant-level data from the Foundation Center; non-governmental organisation (NGO) data from the US Agency for International Development (USAID)’s annual Report of Voluntary Agencies; and a diverse set of audited financial records and annual budgets.

The paper also includes numerous interesting figures.

“Government health expenditure as a source”: In addition to DAH, IHME also tracks GHE-S (government health expenditure as a source) aka the amount that low and middle income countries spend on health. But it’s not clear to me what exactly is included. For instance, if one LMIC spends on a health program in a different LMIC, does that count? If an LMIC moves up from middle income to upper income, what happens? Note that the above chapter also splits DAH into DAH-G and DAH-NG depending on the target of the aid; DAH-G means DAH given to governments and DAH-NG means DAH given to non-governmental entities.

More IHME links:

Some quotes from “The Money Trail: Ranking Donor Transparency in Foreign Aid” by Ghosh and Kharas. Note that the version I have access to lacks figures and tables (there are placeholders marking their locations, but not the figures and tables themselves).

Page 17:

Also, variables like disbursements cannot be accurately matched with commitments, so it is hard to know if projects are actually implemented.

Page 21:

The data for the Transparency Index comes from two main sources:

Page 26:

Donors who are members of the IATI score higher on other dimensions of transparency as well. Indeed, 13 of the top 15 most transparent donors are also members of the IATI. We find that being a member of IATI is a powerful predictor of the donor being more transparent across most of the other dimensions.

“IATI totals for donors tend to be much smaller than apparently-equivalent figures reported through OECD’s system. This is largely because many donors are not reporting all of their activities in the IATI system, or not reporting them fully.” http://roadto2015.org/aidopener

See also http://www.aidopener.org.

AidData, used in “The Money Trail” paper (quoted on this page), also seems interesting. There are precursors called Project-Level Aid Database and Accessible Information on Development Activities (no Wikipedia page).

de Maele, Evans, and Tan-Torres (2013) provides a comparison of several health spending data sources. It includes graphs and a comparison table.

Chapter 13 of DCP2 is on DAH.

For the United States specifically, IHME is also doing the Disease Expenditure project (DEX) which apparently it plans on also expanding to the rest of the world.

There is another report that tallies up DAH. I think the numbers are a little smaller here compared to the reports from IHME.

Other sources to look at for funding info:

See also