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Transcript of council on foreign relations new york financing global health_murray_113010_ihme
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Financing Global Health 2010:
November 30, 2010
Christopher Murray
Director
Development assistance and country spending in
economic uncertainty
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Outline
Why Track Development Assistance for Health?
Financing Global Health 2010 Methods
Key Findings on DAH
Recipient Government Responses
What is Coming in 2011?
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IHME’s work focuses on three questions
1. What are people’s health problems? – e.g., tracking adult, child, or maternal mortality; the Global Burden of Disease 2010
2. How well is society doing in addressing these health problems? – e.g., inputs, outputs, and outcomes from public health, medical care, and other key social determinants
3. What can be done in the future to maximize health improvement? – e.g., cost-effectiveness of major intervention and health system intervention options
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Tracking health financing
• Financing Global Health 2009 tracked Development Assistance for Health (DAH) – flows from key development-focused organizations for the advancement of global health.
• Financing Global Health 2010 tracks DAH and government health expenditures.
• Working on a systematic analysis of all available sources of data on out-of-pocket household expenditures on health for 1990-2010.
• Future editions of FGH will include all three components: DAH, government, and private expenditures on health.
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Outline
Why Track Development Assistance for Health?
Financing Global Health 2010 Methods
Key Findings on DAH
Recipient Government Responses
What is Coming in 2011?
5
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Channels of development assistance for health
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NGO revision for in-kind revenue
• US NGOs claim drug and equipment donations at US wholesale prices, while the donors claim at production costs.
• On average, international prices are only one-quarter to one-fifth of US wholesale prices.
• We have estimated empirically this relationship and deflated all donations to all NGOs by the same average factor. NGO-specific deflators have not been possible to develop.
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Preliminary estimates for donors and agencies
• Financing Global Health 2009 and The Lancet results on financing global health through 2007 reflect the lag in audited financial statements.
• Using audited financial statements and tax returns, we have data for 2008.
• We have developed preliminary estimates for 2009 and 2010 by analyzing the historical relationship between budgets for donors and agencies and disbursements.
• Preliminary estimates for non-US government NGO revenue are the most uncertain.
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Outline
Why Track Development Assistance for Health?
Financing Global Health 2010 Methods
Key Findings on DAH
Recipient Government Responses
What is Coming in 2011?
9
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DAH by channel of assistance, 1990-2010
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Total overseas health expenditures channeled through US NGOs by funding source, 1990-2010
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Fund balances for UN health-related agencies at the end of 2009
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DAH as a percentage of national income, 2008
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Public sector DAH by donor country received by channels of assistance, 2008
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Total DAH per-all cause DALY, 2003-2008
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Top 30 country recipients of DAH versus top 30 countries ranked by all-cause burden of disease
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DAH by health focus area
Scale-up most dramatic for HIV/AIDS, malaria, and tuberculosis.
Maternal, newborn, and child health aid slower but increasing.
NCDs less than $120 million per year in 2008.
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Outline
Why Track Development Assistance for Health?
Financing Global Health 2010 Methods
Key Findings on DAH
Recipient Government Responses
What is Coming in 2011?
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Domestic financing of health by governments has been increasing
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What happens to domestic finance in countries that receive large amounts of DAH?
• Our analysis of how Ministries of Finance respond when governments receive DAH was published April 2010 in The Lancet.
• Responses vary substantially, but on average, finance ministries decrease health expenditures from their own sources by a range of 43 cents to $1.14 for every dollar of DAH received by governments.
• Debate is not about whether this occurs but whether it is welfare-enhancing.
• Perspectives vary widely between macro-economists and health specialists and between donors, Ministries of Health, and Ministries of Finance.
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Outline
Why Track Development Assistance for Health?
Financing Global Health 2010 Methods
Key Findings on DAH
Recipient Government Responses
What is Coming in 2011?
21
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Understanding DAH trends
• Public investment in DAH will be determined by three factors:
o Timing of fiscal contraction in order to reduce debt/GDP ratios. IMF estimates maximum contraction around 2013
o Priority attached to development assistance during fiscal contraction
o Priority assigned to global health within development assistance
• Private investment in DAH likely to follow more closely the economic cycle and asset prices.
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Good news…
• UK austerity budget includes expanded investments in development assistance.
• GFATM replenishment at $11.7 billion for 2011-2013 was lower than projected needs but represents continued growth compared to 2008-2010 replenishment.
• Is this a vote of confidence in GFATM or an early sign of global health’s continued priority more generally?
• Will “preliminary estimates” from the GFATM secretariat of $1.1 billion eventuate?
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Not so good news…
• Comparing 2006-2008 and 2008-2010, there is already evidence of declining or flat rates of growth for many donors.
• Excluding US and UK bilateral, GAVI and GFATM, global health DAH peaked in 2008.
• Continued expansion of global health driven to a large extent by these four channels. GAVI has no leader at present. US budget debate just beginning.
• Broad “corridor discussions” in donor country Ministries of Finance of whether health has been overemphasized in recent years.
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Outcome not predetermined
• The outcome of these key discussions is not predetermined by macro-economic circumstances.
• By emphasizing evidence of the impact of past and current investments, the global health community can influence US and other decision-making on the priority for global health in times of general fiscal contraction.
• Commitment to rigorous monitoring and evaluation of DAH and of government financial response will be key to sustaining financing for global health in the short and medium term.