Global health funding: and beyond By Mark Harrington Treatment Action Group 27 October 2011 Lille, France

Global health funding has increased in recent years.

. McCoy D et al. Health Policy Plan. 2009;24: The global health funding architecture has become much more complex

Global health commitments are larger than disbursements

Health Official Development Assistance (ODA) Commitments by Donor, 2001 & 2008 Total = $7.6 billionTotal = $26.4 billion US$ Billions 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 Total = $7.6 billionTotal = $26.4 billion US$ Billions 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 *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. Global Health Initiative (GHI) $9.8 billion <1%

Independent Agency Labor Peace Corps CDC Homeland Security Commerce EPA The White House Defense USDA NIH FDA HRSA PEPFAR HHS OGHA OPHS MCC PMI Water for Poor NTD Program Department Multi-Agency Initiative Dept. Operating Unit CONGRESSCONGRESS 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, The U.S. Government’s Global Health Architecture USAID Bureaus for: Global Health; Economic Growth, Agriculture & Trade; Democracy, Conflict, Humanitarian Assistance. Missions KEYKEY Treasury GHI State OGAC OES Ambassadors

U.S. Global Health Initiative (GHI) & Other U.S. Global Health Funding, FY 2004-FY 2011 $4.4 $5.2 $6.3 $7.3 $9.8 $10.3 $10.8 In Billions *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 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. $10.7

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 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 * = GHI Plus Country Source: Kaiser Family Foundation. The U.S. Global Health Initiative: A Country Analysis; February In Thousands

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 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): e doi: /journal.pone

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): doi: /heapol/czp026. Published online: July 1, Kaiser Family Foundation. U.S. Global Health Policy globalhealth.kff.org/. OECD. Measuring aid to 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): e doi: /journal.pone