Reading the Bill and Melinda Gates Foundation funded report, “Financing of global health: tracking development assistance for health 1990 to 2007” I couldn’t help but notice dominance of the US government and NGOs among global players funding developmental assistance for health (DAH). The increase in amount is also remarkable, quadrupling since 1990 to a global contribution of 14.08 billion. However, the proportion of US aid as compared to multinational agencies such as the World Bank and UN agencies is also changing markedly. The World Bank for example doled out 21.7% of DAH in 2000 and only 7.2% in 2007. The US government remains the largest donor with the UK, Japan, Germany and other European nations following.
While the numbers may be somewhat familiar, the methods of tabulation might be interesting. The report reads “we were unable to include NGOs and foundations registered in other donor countries [than the US] because of data restrictions”. Later it draws upon eight foreign NGOs “for some select years”, concluding that by only spending a mere $231 million dollars the pattern remains the same, and we can safely exclude the entire world (except the US).
While we may agree with the current significance of foreign contributions is small compared to the US and its flanks of NGOs, I find the methodology at odds with the core purpose of the study and indicative of a more general pattern in the emerging volumes of reports that attempt to study the modern phenomena of global public health. “Health Financing Revisited: a practitioners guide”, offers guidance in warning that, “more resources alone will not lead to better results unless the global community squarely faces the challenge of strengthening the implementation capacity of health systems so that resources translate into better health outcomes for the poor”. Central to our ability to complete the above objective is to do what the Gates funded report claims to: study, categorize and create central databases for tracking finance of DAH. By not only being the largest donor, but also largely controlling the study of financing of health systems, US organizations have a stranglehold on an industry that must at least double its contributions again in order to reach health MDGs.
If this global effort to improve health is going to have any semblance of success, it must be a global effort. Further, if the process of making the world healthier is going to be just, and be fair, (and if it’s going to be successful!) it’s integral that all global players have a stake, both from a financial and policy standpoint. This must start with the social science. GAVI for example is a pioneer in its transparency, allowing for global critique and thus opening itself up for improvement strategies. We must call for similar transparency from other donors and the social sciences also. We need to be able to track in the future, who is making what donations, where and why as health systems continue to expand at an astounding rate. Without integrated, global systems to scrutinize financing relationships more carefully, this multi-billion dollar, rapidly expanding industry is setting itself up for corruption, and inefficiency. At the very least, without greater inclusion of global donors, policy and outcomes will continue to come from US mouths and pockets, for better or for worse.