In some developing countries governments devote as little as US$10 per person to health annually. This is less than a third of the $34 that the World Health Organisation has recommended to provide basic universal health services.
Why the low spending on health?
Weak economies and a small tax base mean most developing countries are dependent on overseas aid. This can be unpredictable and short-term, making long-term health planning almost impossible. Aid can also have strings attached. What’s more, international donors have delivered too little, and at a snail’s pace, despite their grand promises and official announcements.
For example, wealthy countries committed to increase their overseas development assistance to a minimum of 0.7% of their gross national income back in 1970, but only Denmark, Luxembourg, Norway, Sweden and the Netherlands had met the 0.7% target by 2007.
All 53 countries in the African Union made a pledge in Abuja in 2001 to devote 15% of their national budgets to health, but few countries have come close to being able to commit this sum.
Where does money go?
How and where health money is spent is also crucial. Some governments assign 60% or more of their health budget to urban hospitals, which serve only 10% of the population. Indigenous communities can be at particular risk, often marginalised by a combination of their geographical location, weak political power and the cultural prejudices of mainstream health workers.
Many international donors have preferred to attach their names to high profile, ‘disease-specific’ or ‘vertical’ initiatives. These often focus on one particular disease or group of diseases, such as HIV, tuberculosis or malaria. These initiatives have focused attention on health issues, and saved millions of lives, but can also have unintended negative consequences for national health systems if not accompanied by money to strengthen health systems more generally.
There is increasing agreement that the key challenges in global health need concerted efforts to fund stronger health systems, with disease-specific initiatives playing an important role alongside this.
However the explosion of different partnerships and global alliances on health has created a very complex funding environment for health policy makers and governments alike.
A change in emphasis
Vertical initiatives are already reflecting this change of debate. Some vertical initiatives have started to develop mechanisms to ensure they also strengthen health systems. For instance, the Global Alliance on Vaccines and Immunisation (GAVI) has introduced bonus payments for each child vaccinated, which provides money for recipient countries to spend as they wish on their health systems.
Health Poverty Action says:
- It is vital that rich countries and donor institutions massively increase their aid for health, and deliver long-term and predictable funding that will allow developing countries to strengthen their health systems. Wealthy countries must fulfil their pledge of 0.7% of gross national income for aid.
- International non-governmental organisations (NGOs) should play a strong role in monitoring these efforts. NGOs can often speak out when poor country governments are reluctant to criticize the powerful international aid donors they rely on.
- Vertical funding initiatives should contribute a proportion of their budget to the government health budget of each country where they operate, to help strengthen national health systems.
- National governments must make sure health funds support equitable access to services. Funding mobile clinics and health outposts can make all the difference to isolated communities.
Learn more about health funding:
- How much money is needed?
- Who gives what?
- Which African countries have reached Abuja health spending targets?
Last modified: 07/01/2011
