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
Total = $7.6 billion
2008
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
Total = $7.6 billion
2008
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
State
Bureaus for: Global Health;
Economic Growth, Agriculture
& Trade; Democracy, Conflict,
Humanitarian Assistance.
Missions
C
O
N
G
R
E
S
S
HHS
OGAC
OES
Ambassadors
OGHA
OPHS
GHI
CDC
Defense
PMI
NIH
USDA
NTD
Program
FDA
PEPFAR
Water for
Poor
Treasury
MCC
Homeland
Security
EPA
Labor
Commerce
Peace Corps
HRSA
K
E
Y
Department
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
$2.3
$10.3
$1.9
$10.8
$10.7
$1.8
$1.8
$8.9
$8.9
FY 2010
FY 2011
CR
$7.3
$6.3
$5.2
$4.4
$1.1
$3.3
FY 2004
$1.4
$1.8
$1.5
$3.7
FY 2005
$4.5
FY 2006
$5.9
FY 2007
$7.5
FY 2008
$8.4
FY 2009
*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.