Development Assistance for Health as the MDG Deadline Approaches

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What’s it like to be a small fish in a big pond? I’ll tell you - I started my internship with ACTION just under a week ago, so I would say I’m a fairly small fish in the global health advocacy pond. On my third day at the office, I attended a Global Health Council event to discuss the Institute for Health Metrics and Evaluation’s (IHME)report on global health financing. While other college sophomores were sitting in class, I was sitting next to big fish in global health, and I couldn’t have been more excited to get a glimpse into the complicated world of global health financing.

Global health financing is a complex issue, and there is much that has yet to be achieved in global health, but with effective strategies (along with financing), we can work towards achieving the MDG’s and beyond.  ACTION focuses on TB and childhood immunizations, so I was particularly interested in financing trends for those two health topics. What I found most interesting was the significreportant role the GAVI Alliance (GAVI) plays not only in vaccination, but in overall global health financing.

Two things stood out to me:

Firstly, GAVI plays a significant and increasingly important role in financing development assistance for health (DAH). GAVI is much newer compared to more traditional institutions such as UN agencies, and since its establishment in 2000 has experienced sustained growth. The amount of DAH flowing through GAVI became especially pronounced in 2007 and despite the recession, DAH from GAVI has continued to grow. The IHME estimates that its growth rate increased 31% between 2010 and 2011, rising from $893.84 million to $1.17 billion. In many ways, this is a result of successful advocacy by ACTION partners and others to raise the profile and political support for GAVI. These funds have helped GAVI to support the immunization of 326 million additional children, who might not otherwise have had access to vaccines, and will prevent over five million future deaths.

Secondly, the World Bank’s International Bank for Reconstruction and Development accounted for the largest share of expansion ($796.77 million) in DAH between 2010 and 2011 in the form of loans. Some in the global health community contest whether these loans should be counted as DAH, as they are targeted to provide economic stimulus primarily and have to be paid back by governments.

Despite concerns over cutbacks in foreign aid, IHME surprisingly found that DAH continues to grow (but at a much slower rate). Panelists at the Global Health Council event expressed concern over donor preference for “quick wins”, and stressed the negative impact that reduced funding and short-term thinking could have on long-term health systems strengthening. In moving forward, we must identify how to best target limited resources. Developing countries need new tools to better evaluate and address ongoing burdens of infectious diseases. MDG 4, 5, and 6 depend on the trajectory of DAH growth and this requires transparency, accountability, better data gathering, and more thorough impact evaluations.

As I continue my internship with ACTION, I look forward to seeing how global health advocates can help to ensure DAH continues to grow so that it stops tuberculosis and increases vaccine access and uptake for all children around the world.