CATALYST DIALOGUE ON HEALTH FINANCING
Insights from a debate on how to increase funding for health and spend existing funds more effectively.
Catalyst Dialogue participants:
Christoph Benn, Director for Global Health Diplomacy, Joep Lange Institute • Jayati Ghosh, Professor of Economics, Univer...sity of Massachusetts at Amherst • Tom Hart, Research Fellow, ODI • Lesley-Anne Long, President & CEO, Global Business Coalition for Health • Riaz Tanoli, CEO, Social Health Protection Initiative, Health Department Khyber Pakhtunkhwa, Pakistan
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Since the 1970s, voluntary contributions have become an increasingly important component of WHO's budget. As voluntary contributions tend to be earmarked for donor-specified programmes and projects, there are concerns that this trend has diverted focus away from WHO's strategic priorities, made coor...dination and attaining coherence more difficult, undermined WHO's democratic structures and given undue power to a handful of wealthy donors. In the past few years, the WHO Secretariat has pushed for donors to increase the amount of flexible funding they provide.
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There has been no systematic comparison of how the policy response to past infectious disease outbreaks and epidemics was funded. This study aims to collate and analyse funding for the Ebola epidemic and Zika outbreak between 2014 and 2019 in order to understand the shortcomings in funding reporting... and suggest improvements. Methods: Data were collected via a literature review and analysis of financial reporting databases, including both amounts donated and received. Funding information from three financial databases was analysed: Institute of Health Metrics and Evaluation’s Development Assistance for Health database, the Georgetown Infectious Disease Atlas and the United Nations Financial Tracking Service. A systematic literature search strategy was devised and applied to seven databases: MEDLINE, EMBASE, HMIC, Global Health, Scopus, Web of Science and EconLit. Funding information was extracted from articles meeting the eligibility criteria and measures were taken to avoid double counting. Funding was collated, then amounts and purposes were compared within, and between, data sources.
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The majority of Countdown countries did not reach the fourth Millennium Development Goal (MDG 4) on reducing child mortality, despite the fact that donor funding to the health sector has drastically increased. When tracking aid invested in child survival, previous studies have exclusively focused on... aid targeting reproductive, maternal, newborn, and child health (RMNCH). We take a multi-sectoral approach and extend the estimation to the four sectors that determine child survival: health (RMNCH and non-RMNCH), education, water and sanitation, and food and humanitarian assistance (Food/HA). Methods and findings: Using donor reported data, obtained mainly from the OECD Creditor Reporting System and Development Assistance Committee, we tracked the level and trends of aid (in grants or loans) disbursed to each of the four sectors at the global, regional, and country levels. We performed detailed analyses on missing data and conducted imputation with various methods. To identify aid projects for RMNCH, we developed an identification strategy that combined keyword searches and manual coding. To quantify aid for RMNCH in projects with multiple purposes, we adopted an integrated approach and produced the lower and upper bounds of estimates for RMNCH, so as to avoid making assumptions or using weak evidence for allocation. We checked the sensitivity of trends to the estimation methods and compared our estimates to that produced by other studies. Our study yielded time-series and recipient-specific annual estimates of aid disbursed to each sector, as well as their lower- and upper-bounds in 134 countries between 2000 and 2014, with a specific focus on Countdown countries. We found that the upper-bound estimates of total aid disbursed to the four sectors in 134 countries rose from US$ 22.62 billion in 2000 to US$ 59.29 billion in
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The development of this draft Proposed programme budget 2022–2023 comes at a unique moment for WHO. The world is in the grip of the coronavirus disease (COVID-19) pandemic and faces health, social and economic consequences on an unprecedented scale. Although it is not known when the COVID-19 pande...mic will end, recent encouraging vaccine results, in addition to the examples of countries that have achieved good results through public health measures, hold out the prospect of better days ahead. The full impact of the pandemic cannot yet be determined. But whatever its implications, the Secretariat will rise to the challenge and is ready to adapt so that it is fully equipped to support Member States for any eventuality in the future – to make sure that the world will never again have to face this kind of crisis.
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Japan has been implementing projects of global extension of medical technologies under an official development assistance policy to improve public health and medicine by promoting Japanese medical technologies worldwide. The current work examines the impact and goals of implementing this new scheme.... The scheme has involved dozens of projects that sent Japanese experts to partner countries and that invited their counterparts to Japan to showcase Japanese medical technologies. Approximately 50 projects have been implemented in 24 countries over 5 years, and 19,638 individuals have been trained. As a result, the introduced technology was adopted in national guidelines in 4 projects and the introduced equipment was procured in the partner country in 17 projects. In total, 912,334 individuals have benefitted from the introduction of these medical technologies. The concept of "creating shared value" (CSV) could help promote project success by both creating economic value and encouraging social progress. However, the sustainability of that business model remains in question in terms of the internationalization of CSV. Several successful projects improved medical care and led to new business opportunities.
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Over the 20 years that followed, this unique partnership has invested more than US$53 billion, saving 44 million lives and reducing the combined death rate from the three diseases by more than half in the countries in which the Global Fund invests.
Strengthening resource tracking and monitorig health expanditure
Since the last situation report on the multi-country outbreak of cholera was published on 6 July 2023 (covering data reported until 15 of June), and as of 15 July 2023, one new outbreak of cholera was reported from India on 15 May 2023. In total, 25 countries have reported cases since the beginning ...of 2023. The WHO African Region remains the most affected region with 14 countries reporting cholera cases since the beginning of the year. The overall capacity to respond to the multiple and simultaneous outbreaks continues to be strained due to the global lack of resources, including shortages of the Oral Cholera Vaccine (OCV) and cholera supplies, as well as overstretched public health and medical personnel, who are dealing with multiple parallel disease outbreaks and other health emergencies. Based on the large number of outbreaks and their geographic expansion, as well as a lack of vaccines and other resources, WHO continues to assess the risk at global level as very high.
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Access to safe blood and blood products is recognized as one of the key requirements for delivery of modern health care in the journey towards health for all. The foundation of safe and sustainable blood supplies depends on the collection of blood from voluntary non-remunerated and low-risk donors. ...Data from the WHO Global Database for Blood Safety (GDBS) brings out several inadequacies related to the supply and safety of blood and blood products. These inadequacies include a number of variations in safe blood practices across the world, including the quantity of blood donated (voluntary and replacement types), quality and adequate testing of the donated blood (immunohaematology [IH] and transfusion-transmitted infections [TTIs]), rational use of blood and blood components such as appropriate patient blood management protocols. These variations are very high in countries of the South-East Asian Region and most of them are either low- or middle-income countries (LMICs).
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Previous advocacy efforts have achieved tangible goals in terms garnering political commitments
to increase financing for TB—as seen at the 2018 UN High-Level Meeting on TB. The challenge
now is to ensure that these commitments are actually met within a global biomedical research
ecosystem that... is designed and incentivized to prioritize the health needs of wealthy populations
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Four initiatives have estimated the value of aid for reproductive, maternal, newborn, and child health
(RMNCH): Countdown to 2015, the Institute for Health Metrics and Evaluation (IHME), the Muskoka Initiative, and
the Organisation for Economic Co-operation and Development (OECD) policy marker. We... aimed to compare the
estimates, trends, and methodologies of these initiatives and make recommendations for future aid tracking.
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This brief update on tuberculosis (TB) in the African region covers the state of TB in the WHO African region, strategic priorities and targets and the impact of COVID-19 on essential services. This is followed by key figures for the region, the role of WHO in country support and, recognizing the im...portance of diagnosis and drug susceptibility testing, a focus onstrengthening laboratory networks and the regional laboratory and diagnostic objectives. A brief update of the state of the science and how this is funded across the African region is provided, before closing with challenges and opportunities,strategic directions and a brief discussion of funding concerns. Discussions around the drivers of the disease, and issues of the poverty, inequality and stigma that continue to plague those living with TB are fully recognized, but are outside the scope of this report.
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To provide information on trends on official development assistance (ODA) disbursement patterns for
reproductive health activities in 18 conflict-affected countries
In an ambitious new era for health development under the 2030 Agenda for Sustainable Development, WHO and
its partners have a solid foundation of success on which to build. Health plays a fundamental role in development
and is the central focus of Sustainable Development Goal 3, “Ensure healthy ...lives and promote well-being for all
at all ages”. It is also relevant to all the Sustainable Development Goals. Understanding the significance of the
role of health is a prerequisite for successful collective action on the social, economic and environmental
determinants of health
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In In recent years, China has increased its international engagement in health. Nonetheless, the lack
of data on contributions has limited efforts to examine contributions from China. Existing estimates that track
development assistance for health (DAH) from China have relied primarily on one data...set. Furthermore, little is known
about the disbursing agencies especially the multilaterals through which contributions are disbursed and how these
are changing across time. In this study, we generated estimates of DAH from China from 2007 through 2017 and
disaggregated those estimates by disbursing agency and health focus area.
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Development assistance for health (DAH) is an important part of financing healthcare in low- and middle-income countries. We estimated the gross disbursement of DAH of the 29 Development Assistance Committee (DAC) member countries of the Organisation for Economic Co-operation and Development (OECD) ...for 2011–2019; and clarified its flows, including aid type,
channel, target region, and target health focus area. Data from the OECD iLibrary were used. The DAH definition was based on the OECD sector classification. For core funding to non-healthspecific multilateral agencies, we estimated DAH and its flows based on the OECD methodology for
calculating imputed multilateral official development assistance (ODA).
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Reproductive health needs are particularly acute in countries affected by armed conflict. Reliable information
on aid investment for reproductive health in these countries is essential for improving the efficiency and effectiveness of
aid. The purpose of this study was to analyse official developm...ent assistance (ODA) for reproductive health activities in
conflict-affected countries from 2003 to 2006.
Methods and Findings: The Creditor Reporting Syst
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This document presents the World Health Organization Operational framework for building climate resilient and low carbon health systems*. ***The framework's goal is to increase the climate resilience of health systems to protect and improve the health of communities in an unstable and changing clima...te, while optimizing the use of resources and implementing strategies to reduce GHG emissions. It aims to contribute to the design of transformative health systems that can provide safe and quality care in a changing climate.
Implementation of the framework's ten components would help health organizations, authorities, and programmes to be better able to anticipate, prevent, prepare for, and manage climate-related health risks and therefore decrease the burden of associated climate-sensitive health outcomes. Implementing low carbon health practices would contribute to climate change mitigation while also improving health outcomes. Achieving these aims is an important contribution to universal health coverage (UHC), global health security, and specific targets within the Sustainable Development Goals (SDGs). The document is a useful resource for decision-makers in health systems, including public health agencies, and other specialized institutions, and for decision-makers in health-determining sectors.
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Heart failure with a reduced ejection fraction (HFrEF) is a condition frequently encountered by healthcare professionals and, in order to achieve the best outcomes for patients, needs to be managed optimally. This guideline document is based on the European Society of Cardiology Guidelines for the t...reatment of acute and chronic heart failure published in 2016, and summarises what is considered the best current management of patients with the condition. It provides information on the definition, diagnosis and epidemiology of HFrEF in the African context. The best evidence-based treatments for HFrEF are discussed, including established therapies (beta-blockers, ACE-i/ARBs, mineralocorticoid receptor antagonists (MRAs), diuretics) that form the cornerstone of heart failure management as well as therapies that have only recently entered clinical use (angiotensin receptor-neprilysin inhibitor (ARNI), sodium/glucose cotransporter-2 (SGLT2) inhibitors). Guidance is offered in terms of more invasive therapies (revascularisation, implantable cardioverter defibrillators (ICDs) and cardiac resynchronisation therapy (CRT) by implantation of a biventricular pacemaker with (CRT-D) or without (CRT-P) an ICD, left ventricular assist device (LVAD) use and heart transplantation) in order to ensure efficient use of these expensive treatment modalities in a resourcelimited environment. Furthermore, additional therapies (digoxin, hydralazine and nitrates, ivabradine, iron supplementation) are discussed and advice is provided on general preventive strategies (vaccinations). Sections to discuss conditions that are particularly prevalent in sub-Saharan Africa (HIV-associated cardiomyopathy (CMO), peripartum CMO, rheumatic heart disease, atrial fibrillation) have been added to further improve clinical care for these commonly encountered disease processes.
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