1. Funding for the Global Burden of Disease
Victoria Bakare

2. Questions to consider…
Where is the money coming from? Who does the money go to? Who decides what is important? What will change in the next 10 years?

3. Where is the money coming from?

4. Funding for the Global Burden of Disease
Increase the investment in global health over the last decade
According to the World Bank, development assistance for health grew from US$2.5 billion in 1990 to almost US$14 billion in 2005
Increase in the number of global health actors
Donors- international and otherwise
Government and public taxes
Business and corporate organisations

6. The Donors
Bilateral development agencies Development Banks UN Agencies The Global Fund GAVI Alliance The Gates Foundation Other Non-governmental organisations and charities

7. The Donor Priorities
Flagship missions for specific conditions in health e.g. The Global Fund, GAVI Alliance Millennium Development Goals and other international development goals for health The ‘Sexy Diseases’ The measurable outcomes e.g. BMGF and the eradication of polio

8. Who does the money go to?

9. The Recipients
National Governments Ministries and departments of health Local charities and nongovernmental organisations Hospitals and private organisations The Individual

10. The Recipient Priorities
Allocation and distribution of national funds to local agencies and initiatives Balancing donor requirements and national/local capacity Prioritizing the health need over the tagged financing Millennium Development Goals and other international/regional goals for health Political priorities that exist within the different countries

11. The individual? What does the individual pay for? Healthcare
Medication
Transport to and from hospital
Upkeep in hospital
How does the individual pay for health care?
Financial burden on the individual to pay for health care shifts as the epidemiology of disease changes
e.g. NCDs- more chronic conditions requiring long term medications and care

12. Who decides what is important?

13. Donors, Recipients and the Global Burden of Disease
Does the donor priorities match the recipient priorities?
Does the recipient priorities reflect the donor priorities or the global burden of disease?
Who should decide where the money goes?
Donors?
Recipients?
The burden of disease?

14. The ethics of financing the global burden of disease
Unidirectional funding- flows only from high income to low income countries Issues with allocated funds not reaching their intended purposes Lack of coordination and unification in the delivery of the health system Difficulties in balancing donor and recipient priorities

15. A Case Study: Malawi
The largest donations received by the Government in Malawi have come from the Global Fund for AIDS, TB and Malaria, who since 2002 have donated over US$300 million- with around 80% of earmarked to fund HIV/AIDS programmes. Consequently, the role of the GFATM in priority-setting and planning for national health in Malawi has had its complications. It was reported that there have been concerns raised about the lack of integration of GFATM activities into the health sector planning by the government. There were also parallel planning structures for the Malawi National AIDS Committee Integrated National Working Plan and the GFATM Plans

16. What will change in the next 10 years?

17. The future for financing the global burden of disease?
Less reliant on international donors and more focus on building resilient health systems to effectively manage the burden of disease The Sustainable Development Goals- what does this mean for health financing and the priority on a global level NCDs > CDs? The concept of ‘Universal Health Coverage’

18. Key conclusions
Increase in global health funding over the past decade Challenges in tracking the volume of global health expenditure; the source of this funding; its management; and how it is spent A detailed description of global health funding is needed to improve the efficiency, accountability, performance and equity Necessary to track and monitor the activities of donors as well as the funding that is sourced by and channelled through private actors Importance of balancing priorities in between donors, recipients and the actual burden of disease

19. Questions?