1. Global Health Funding
Kaiser Permanente Resident Elective Health Policy Program
10 May 2017
Prof. Corrina Moucheraud
UCLA Fielding School of Public Health

2. Overview of financing types & trends
Estimated minimum expenditure, per capita per year, for basic life-saving services: US$ 44
34 countries are below US$50 / year (7 are < $20)
WHO Fact Sheet, “Spending on health: A global overview” (2012).

3. Per capita total health expenditure (US$)
WHO Global Health Expenditure Database

4. Typology of global health institutions
PUBLIC
PRIVATE
Bloom BR. (2011). WHO Needs Change. Nature.

5. Don’t forget about domestic health financing!
Public
Unearmarked or earmarked
Taxes
Private
Voluntary pre-payment
Out-of-pocket

6. Govt expenditure on health as % of total health expenditure
WHO Global Health Expenditure Database

7. Out-of-pocket expenditure as % of private expenditure on health
WHO Global Health Expenditure Database

8. External resources as % of total expenditure on health
WHO Global Health Expenditure Database

9. Health development assistance
Public funds
Bilateral aid
govt A  country B (* or organization/company B)
Multilateral aid
countries A, B, C  agency  countries, regions, etc
Private funds
Foundations (e.g., Gates Foundation) & charities
Corporations
Innovative financing mechanisms

10. Bilateral aid
Many high-income countries have official development assistance (ODA) organizations within the govt
Usually within foreign affairs or trade ministries
In US: US Agency for International Development (USAID), within State Dept

11. Remember that health is only 1 sector!
OCED-DAC,

12. USAID mission
“We partner to end extreme poverty and promote resilient, democratic societies while advancing our security and prosperity.”
World’s largest ODA agency; but one of the lowest allocations as % of GNI
Total ODA, as % of gross national income,
OECD (2016), Net ODA (indicator). doi: / en

13. Multilateral agencies
UN agencies:
World Health Organization
UNICEF
UNAIDS
World Bank
Others too (e.g., regional development banks)

14. Major UN organizations & agencies working on health
World Health Organization (WHO)
UN Children Fund (UNICEF)
UN Development Programme (UNDP)
UN High Commissioner for Refugees (UNHCR)
UN Population Fund (UNFPA)
UNAIDS
UN Environment Program (UNEP)
Food and Agriculture Organization (FAO)
International Labour Organization (ILO)
UN Conference on Trade and Development (UNCTAD)
… and many more

15. WHO activities
Normative functions: intl conventions, agreements, regulations, standards, recommendations
Directing & coordinating functions: including disease-specific programs
Research & technical cooperation: emergencies, disease eradication

16. WHO financials Where does WHO get its money?
“Assessed contributions” (dues)
Calculated biannually for each member, based on population & economy size
“Voluntary contributions” (earmarked $)
programme budget – financed by:
Assessments: US$ 929 million
Voluntary contributions: US$ 3.5 billion

17. Programme budget changes

18. UNICEF
Unlike WHO, UNICEF has an implementation function and strong in-country presence
1946: created with focus on emergency food & healthcare after WWII
Annual budget: ~$4 billion – from countries, private sources (including individuals, corporate sponsors)
Current ED: Anthony Lake (2010-)

19. UNICEF Annual Report 2015

20. World Bank Group “World Bank” International Finance Corporation
International Bank for Reconstruction and Development (IBRD)
Loans to middle-income countries
International Development Association (IDA)
Loans & grants to poor (plus non creditworthy) countries (n=77)
International Finance Corporation
Private-sector development
Multilateral Investment Guarantee Agency
International Centre for Settlement of Investment Disputes

21. Structure of the WBG
Member govts contribute to the capital of each institution, and get voting rights
Assigned votes at time of membership: 250 votes + 1 per share in Bank capital (based on size of economy)
Can add votes later with additions to capital
Some votes depend on $ contribution

22. Voting distribution IBRD DISTRIBUTION: USA: 16.7% Japan: 7.2%
China: 4.65%
Germany: 4.22%
France: 3.95%
UK: 3.95%
Russia: 2.91%
Italy: 2.53%
IDA DISTRIBUTION:
USA: 10.36%
Japan: 8.36%
UK: 5.99%
Germany: 5.4%
France: 3.78%
Saudi Arabia: 3.2%
India: 2.93%
China: 2.1%

23. 2015 funding for IBRD & IDA (Remember, not just health!)
Compare to WHO or UNICEF budgets...

24.
Dieleman et al, 2017, Evolution and patterns of global health financing 1995–2014: development assistance for health, and government, prepaid private, and out-of-pocket health spending in 184 countries. Lancet.

25. Dieleman et al, 2016, Development assistance for health: past trends, associations, and the future of international financial flows for health. Lancet.

26. Dieleman et al, 2016, Development assistance for health: past trends, associations, and the future of international financial flows for health. Lancet.