Patterns of funding allocation for tuberculosis control in fragile states

Disparities in Health Financing Allocation among Infectious Diseases in Ebola Virus Disease (EVD)-Affected Countries, 2005–2017

The Ebola virus disease (EVD) outbreaks impacted the population health due to overstretched health systems and disrupted essential health services. Despite a call to achieve equal financial allocation depending on public health needs, there has been scant examination of the fairness of investment among infectious diseases. This study analyzes the extent to which equitable development assistance for health (DAH) has been provided in accordance with disease burden in EVD-affected countries. Estimates of disability-adjusted life years (DALYs) in the Global Burden of Disease (GBD) Study 2017 and DAH Database 1990–2019 in 2005–2017 were analyzed by disease category: vaccine-preventable diseases (VPDs), HIV/AIDS, malaria, tuberculosis, and EVD. HIV/AIDS generally recorded higher ratios of DAH per DALYs (DAH/DALYs). Malaria and tuberculosis showed different trends by country, and VPDs generally presented lower ratios. In West Africa in 2013–2016, DAH/DALYs surged in EVD and fluctuated in HIV/AIDS and malaria. Tuberculosis and VPDs consistently recorded lower ratios. To achieve the risk reduction during and after health emergencies, optimal funding allocation between diseases based on the disease burden is warranted in the pre-emergency period, along with measurement of immediate health needs of populations in real-time during an emergency.

Tracking aid for global health goals: a systematic comparison of four approaches applied to reproductive, maternal, newborn, and child health

Background

Four initiatives have estimated the value of aid for reproductive, maternal, newborn, and child health (RMNCH): Countdown to 2015, the Institute for Health Metrics and Evaluation (IHME), the Muskoka Initiative, and the Organisation for Economic Co-operation and Development (OECD) policy marker. We aimed to compare the estimates, trends, and methodologies of these initiatives and make recommendations for future aid tracking.

Methods

We compared estimates of aid for RMNCH from the four initiatives for all years available at the time of our analysis (1990–2016). We used publicly available datasets for IHME and Countdown. We produced estimates for Muskoka and the OECD policy marker using data in the OECD Creditor Reporting System. We sought to explain differences in estimates by critically comparing the methods used by each approach to identify and analyse aid, and quantifying the effects of these choices on estimates.

Findings

All four approaches indicated substantial increases over time in global aid for RMNCH, but estimates of aid amounts and year-on-year trends differed substantially, especially for individual donors and recipient countries. Muskoka (US$ 13·0 billion in 2013, constant 2015 US$) and Countdown's RMNCH estimates ($13·1 billion in 2013) tended to be the highest and most similar, although they often indicated different year-on-year trends. IHME produced lower estimates ($10·8 billion in 2013), which often indicated different trends from the other approaches. The OECD policy marker produced by far the lowest estimates ($2·0 billion in 2013) because half of bilateral donors did not report on it consistently and those who did tended to apply it narrowly. Estimates differed across approaches primarily because of differences in methods for distinguishing aid for RMNCH from aid for other purposes; adjustments for inflation, exchange rates, and under-reporting; whether donors were credited for their support to multilateral institutions; and the handling of aid to unspecified recipients.

Interpretation

The four approaches are likely to lead to different conclusions about whether individual donors and recipient countries have fulfilled their obligations and commitments and whether aid was sufficient, targeted to countries with greater need, or effective. We recommend that efforts to track aid for the Sustainable Development Goals reflect their multisectoral and interconnected nature and make analytical choices that are appropriate to their objectives, recognising the trade-offs between simplicity, timeliness, precision, accuracy, efficiency, flexibility, replicability, and the incentives that different metrics create for donors.

Funding

Subgrant OPP1058954 from the US Fund for UNICEF under their Countdown to 2015 for Maternal, Newborn and Child Survival Grant from the Bill & Melinda Gates Foundation.

Tracking official development assistance for reproductive health in conflict-affected countries: 2002-2011

OBJECTIVE

To provide information on trends on official development assistance (ODA) disbursement patterns for reproductive health activities in 18 conflict-affected countries.

DESIGN

Secondary data analysis.

SAMPLE

18 conflict-affected countries and 36 non-conflict-affected countries.

METHODS

The Creditor Reporting System (CRS) database was analyzed for ODA disbursement for direct and indirect reproductive health activities to 18 conflict-affected countries (2002-2011). A comparative analysis was also made with 36 non-conflict-affected counties in the same 'least-developed' income category. Multivariate regression analyses examined associations between conflict status and reproductive health ODA and between reproductive needs and ODA disbursements.

MAIN OUTCOME MEASURES

Patterns of ODA disbursements (constant U.S. dollars) for reproductive health activities.

RESULTS

The average annual ODA disbursed for reproductive health to 18 conflict-affected countries from 2002 to 2011 was US$ 1.93 per person per year. There was an increase of 298% in ODA for reproductive health activities to the conflict-affected countries between 2002 and 2011; 56% of this increase was due to increases in HIV/AIDS funding. The average annual per capita reproductive health ODA disbursed to least-developed non-conflict-affected countries was 57% higher than to least-developed conflict-affected countries. Regression analyses confirmed disparities in ODA to and between conflict-affected countries.

CONCLUSIONS

Despite increases in ODA for reproductive health for conflict-affected countries (albeit largely for HIV/AIDS activities), considerable disparities remains.

TWEETABLE ABSTRACT

Study tracking 10 years of aid for reproductive aid shows major disparities for conflict-affected countries.

Global Tuberculosis Control: Toward the 2015 Targets and Beyond

Since 1990, progress has been made toward global tuberculosis (TB) control, as measured by targets set for 2015. However, TB remains a major threat to health around the world. In 2013, there were an estimated 11 million prevalent cases, and an estimated 9.0 million incident cases occurred globally. Approximately 1.5 million deaths were caused by TB, including 360,000 among people living with HIV. Substantial challenges threaten future control efforts. These include multidrug-resistant forms and co-infection with HIV, as well as other factors, such as the increased prominence of noncommunicable diseases and adverse socioeconomic conditions. Beyond 2015, TB control must be seen as both a public health imperative unto itself and a vital component of economic development plans. To that end, control strategies should exploit technical and operational innovations to improve TB control and care and should promote universal health coverage and social protection mechanisms to expand access to essential prevention, diagnostics, and treatment services while avoiding catastrophic costs incurred by patients.

Exploring the influence of the Global Fund and the GAVI Alliance on health systems in conflict-affected countries

Background

Global Health Initiatives (GHIs) respond to high-impact communicable diseases in resource-poor countries, including health systems support, and are major actors in global health. GHIs could play an important role in countries affected by armed conflict given these countries commonly have weak health systems and a high burden of communicable disease. The aim of this study is to explore the influence of two leading GHIs, the Global Fund and the GAVI Alliance, on the health systems of conflict-affected countries.

Methods

This study used an analytical review approach to identify evidence on the role of the Global Fund and the GAVI Alliance with regards to health systems support to 19 conflict-affected countries. Primary and secondary published and grey literature were used, including country evaluations from the Global Fund and the GAVI Alliance. The WHO heath systems building blocks framework was used for the analysis.

Results

There is a limited evidence-base on the influence of GHIs on health systems of conflict-affected countries. The findings suggest that GHIs are increasingly investing in conflict-affected countries which has helped to rapidly scale up health services, strengthen human resources, improve procurement, and develop guidelines and protocols. Negative influences include distorting priorities within the health system, inequitable financing of disease-specific services over other health services, diverting staff away from more essential health care services, inadequate attention to capacity building, burdensome reporting requirements, and limited flexibility and responsiveness to the contextual challenges of conflict-affected countries.

Conclusions

There is some evidence of increasing engagement of the Global Fund and the GAVI Alliance with health systems in conflict-affected countries, but this engagement should be supported by more context-specific policies and approaches.