How much money is needed to deliver essential health services?
The World Health Organisation (WHO) Commission on Macroeconomics and Health has calculated that an extra $27 billion per year is needed to deliver basic health services in middle- and low-income countries.
This is equivalent to international donors multiplying their health spending by five.
The Commission estimates that the figure will rise to $38 billion by 2015.
The WHO has recommended that $34 per person is spent on health systems to provide basic universal health services. This is significantly more than existing levels – which are around the $13–21 mark. $34 would cover the essentials, such as training and recruiting health workers to provide basic maternal and child health services, and to respond to patients with key communicable diseases. At present some developing countries devote as little as $10 per capita to health.
Which African countries have reached the Abuja health spending targets?
Just four African countries – Malawi, Liberia, Rwanda and Burkina Faso – had reached the Abuja target of allocating 15% of their national budgets to health by 2007. However, even if it is reached, 15% of a small or declining budget is not sufficient to make major inroads into poor health.
Outside Africa, the Cambodian government has allocated 17% of its budget towards health in its 2006-10 national strategic development plan.
Which donor countries have furthest to go to meet their pledges on overseas development aid?
2007 saw average overseas aid from all wealthy countries reduce overall from 0.31% to 0.28% of gross national income – way off the 0.7% pledge made in 1970. Norway provided the highest percentage of its income (0.95%). The US provided the highest actual aid amount ($21.8 billion) but this represented only 0.16% of its income.
UK aid slipped from $12.5 billion in 2006 (0.51%) to $9.8 billion in 2007 (0.36%). The UK government has said it will meet the pledge of 0.7% by 2013. Most other EU countries now say that they will try to meet the target by 2015 – but most look way off track.
See the OECD’s full charts for each donor country (Please note, this is an external link and will open in a new window)
What difficulties can arise from overseas aid?
A number of difficulties can arise for countries receiving overseas aid:
- There can be a high administrative burden on governments who must coordinate a number of different donors operating within their country, often reporting separately on each one, sometimes according to different evaluation criteria. At one point Tanzania was producing about 2,400 reports annually to donors, and 8,000 audit reports just for multilateral development banks. In recent years there has been a commitment by donors to move towards harmonisation of reporting requirements to reduce this burden, but there is still a long way to go.
- To get access to aid and loans, governments may be forced to stick to the International Monetary Fund’s crash diet of strict tax policies, or to adopt economic policies that they would not freely choose. These policies can put the control of inflation above providing essential services such as health.
- With overseas aid comes a risk that decision-making shifts away from developing country governments and their citizens. International donors – whether other countries’ aid agencies, health partnerships, international banks or foundations – are not accountable to citizens. These institutions and bodies can bring in much needed money and expertise, but there is a risk that decisions are not made at a local or national level.
Last modified: 13/01/2011
