Donor landscape for health systems

1
Donor landscape for health systems
September 18, 2008 Karl Brown
2
Global Health Spending

• 5-6 Trillion USD (80 in OECD)
• 1 Trillion USD in non-OECD countries
• 16 Billion USD in donor funding (1-2 of
  total, 14 in Africa)

3
Bilaterals, UN and multilaterals make up majority
of global health giving
2006 global health giving
USB
1
1. Includes European Commission, Global Fund for
AIDS, TB and Malaria and Global Alliance for
Vaccines and Immunization Source Global
Monitoring Report 2008
4
US nearly half of all bilateral giving, but
western Europe, Nordics and Japan key donors as
well
2006 bilateral global health giving
US M
92 of all bilateral giving, 51 of total global
health giving
Source OECD CRS database
5
Gates dominates private global health
givingClinton, Ford, Packard, Hewlett, Buffett
and Rockefeller make up 60 of other funding
2006 Non-Gates private nonprofit global health
giving
US M
2006 private nonprofit global health giving
Independent foundation
Corporate foundation
US M
16
84
Note Foundation Center only reports grant money
committed, not grant money paid therefore,
assumed that 60 of grants committed in a year
are paid that year (true for Gates and
Rockefeller) Source Foundation Center,
foundation websites and annual reports, BCG
analysis
6
Health systems represents 2B of total GPH
contributions Excludes IDA, non-UN multilateral,
and Private Nonprofit
2006 global health breakdown
(B)
Source Online query of two sectors in the OECD
Creditor Reporting System (CRS) Database (1)
Health (2) Population Policies Reproductive
Health Note Data only includes
bilateral and some multilateral agencies, and
does not include private non-profit organizations
7
12 target countries have small HS
contributionsBangladesh only target country
where improving health systems donor priority
Total GPH contributionfor each target county
THS Initiatives spending fraction oftotal PH
contributions
(M)
Total contribution ()
Medical reserach and services
Reproductive health
Basic health
Vertical disease control
Improving health systems
Source xxxx
8
Country snapshot Bangladesh
253
2006 GPH contribution breakdown
GPH donor breakdown
(M)
(M)
356
France 40
Netherlands 47
56
UNICEF 7
GFATM 49
United States 16
Germany 64
United Kingdom 185
Bilaterals
Total
Multilaterals
HSinitiatives
Reproductivehealth
Verticaldiseasecontrol
Basichealth
Medicalresearchand services
Total
2006 Health Systems contribution breakdown
HS donor breakdown
(M)
(M)
248
United States 12
6
UNICEF 6
Netherlands 47
United Kingdom 185
Total
Multilaterals
Bilaterals
Pers'l dev'tfor pop'nand reprod'nhealth
Healtheducation
Health policyand adminmgmt
Populationpolicy andadmin mgmt
Medicaleducation/training
Healthpersonneldevelopment
Total
Source Online query of two sectors in the OECD
Creditor Reporting System (CRS) Database (1)
Health (2) Population Policies Reproductive
Health. Query further specified twelve recipient
countries and sub-codes within the two sectors.
Note Data only includes bilateral and some
multilateral agencies, and does not include
private non-profit organizations
9
Country snapshot Cambodia
2
2006 GPH contribution breakdown
GPH donor breakdown
(M)
(M)
46
UNICEF 4
61
Belguim 4
GTATM 39
Japan 5
Germany 9
United States38
Bilaterals
Multilaterals
Total
Verticaldiseasecontrol
HSinitiatives
Reproductivehealth
Basichealth
Medicalresearchand services
Total
2006 Health Systems contribution breakdown
HS donor breakdown
(M)
(M)
5
GFATM 2
5
UNICEF 3
Germany 1
Finland 1
Japan 4
Bilaterals
Multilaterals
Total
Pers'l dev'tfor pop'nand reprod'nhealth
Health policyand adminmgmt
Populationpolicy andadmin mgmt
Healtheducation
Medicaleducation/training
Total
Healthpersonneldevelopment
Source Online query of two sectors in the OECD
Creditor Reporting System (CRS) Database (1)
Health (2) Population Policies Reproductive
Health. Query further specified twelve recipient
countries and sub-codes within the two sectors.
Note Data only includes bilateral and some
multilateral agencies, and does not include
private non-profit organizations
10
Country snapshot Nigeria
4
2006 GPH contribution breakdown
GPH donor breakdown
(M)
(M)
154
IDA 53
GFATM 72
236
United Kingdom 74
United States 153
Bilaterals
Multilaterals
Total
Verticaldisease control
Basichealth
HSinitiatives
Reproductivehealth
Medicalresearchand services
Total
2006 Health Systems contribution breakdown
HS donor breakdown
(M)
(M)
19
EC 4
UNICEF 15
39
United States 2
United Kingdom 36
Bilaterals
Multilaterals
Total
Pers'l dev'tfor pop'nand reprod'nhealth
Health policyand adminmgmt
Populationpolicy andadmin mgmt
Total
Medicaleducation/training
Healtheducation
Healthpersonneldevelopment
Source Online query of two sectors in the OECD
Creditor Reporting System (CRS) Database (1)
Health (2) Population Policies Reproductive
Health. Query further specified twelve recipient
countries and sub-codes within the two sectors.
Note Data only includes bilateral and some
multilateral agencies, and does not include
private non-profit organizations
11
Country snapshot Rwanda
5
2006 GPH contribution breakdown
GPH donor breakdown
(M)
(M)
81
UNICEF 4
GFATM 77
87
Belgium 10
United States 67
Bilaterals
Multilaterals
Total
Verticaldisease control
Basichealth
HSinitiatives
Reproductivehealth
Medicalresearchand services
Total
2006 Health Systems contribution breakdown
HS donor breakdown
(M)
(M)
2
UNICEF 2
2
Spain 0.3
Germany 1
Bilaterals
Multilaterals
Total
Pers'l dev'tfor pop'nand reprod'nhealth
Populationpolicy andadmin mgmt
Total
Medicaleducation/training
Health policyand adminmgmt
Healthpersonneldevelopment
Healtheducation
Source Online query of two sectors in the OECD
Creditor Reporting System (CRS) Database (1)
Health (2) Population Policies Reproductive
Health. Query further specified twelve recipient
countries and sub-codes within the two sectors.
Note Data only includes bilateral and some
multilateral agencies, and does not include
private non-profit organizations
12
Country snapshot Uganda
3
2006 GPH contribution breakdown
GPH donor breakdown
(M)
(M)
7
220
UNICEF 7
UK 37
US 155
Total
Bilaterals
Multilaterals
Reproductivehealth
Verticaldiseasecontrol
HSinitiatives
Basichealth
Medicalresearchand services
Total
2006 Health Systems contribution breakdown
HS donor breakdown
(M)
(M)
6
UNICEF 6
16
Belgium 3
US 5
Ireland 7
Bilaterals
Multilaterals
Total
Pers'l dev'tfor pop'nand reprod'nhealth
Healtheducation
Health policyand adminmgmt
Populationpolicy andadmin mgmt
Medicaleducation/training
Healthpersonneldevelopment
Total
Source Online query of two sectors in the OECD
Creditor Reporting System (CRS) Database (1)
Health (2) Population Policies Reproductive
Health. Query further specified twelve recipient
countries and sub-codes within the two sectors.
Note Data only includes bilateral and some
multilateral agencies, and does not include
private non-profit organizations
13
Vertical funding for horizontal systems?

• Outcomes from recent Bellagio conference
• - Several initiatives starting to examine issue
  (WHO, USAID, Columbia U, Harvard U, others)
• - Difference between vertical funding, vertical
  governance, and vertical implementation - the
  latter is the most problematic
• "Optimistic" areas
• models of chronic care delivery (Systems they
  have piloted for chronic care - appointments,
  adherence support, defaulter tracing,
  record-keeping, can almost certainly be
  transferred to care of other chronic diseases
  like diabetes, HTN, etc)
• clinical services (In many settings, HIV
  programs have emphasized and provided resources
  for clinical mentoring/supervision,
  task-shifting, and training, all of which have
  led to improvements in quality of care etc)
• laboratory upgrades (in terms of physical
  infrastructure and equipment, but also training,
  lab management and QA programs)
• medical records, monitoring evaluation, use of
  data to manage programs, attention to
  privacy/confidentiality of data
• clinical infrastructure
• involvement/empowerment of patients and
  communities in health (transparency re
  priorities, target-setting, etc)

14
Contd

• "Pessimistic" areas (where impact of HIV scale-up
  is causing most
• concern)
• Human resources (Concern that increased
  attention/funding causes brain-drain within
  system, although it may also decrease
  emigration/spur nurses etc to return to service).
• Reporting systems (need to avoid 'silo' systems
  for PEPFAR data, respect the "three ones", and
  use interoperable systems)
• And of course, poor implementation can undermine
  other programs completely - strong need to
  integrate HIV into primary care, not create
  completely vertical program at the clinic level.

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Grantmaking criteria in HIS

• Based on stated need and diverse user
  requirements (community workers, district
  managers, MoH, pvt sector, etc)
• Aligned with country plan for HIS
• Based on interoperable, open standards not
  silos
• Done in the context of systems thinking, with an
  architecture in mind
• Built-in plan for robust evaluation and
  publication of results
• Clear statement of problem and expected impact
• Based on in-country capacity, and plan to use
  project to expand in-country capacity