Academic journal article Bulletin of the World Health Organization

Where Did All the Aid Go? an In-Depth Analysis of Increased Health Aid Flows over the Past 10 years/Ou Est Allee Toute L'aide Sanitaire? Analyse Approfondie Des Flux Croissants D'aide Sanitaire Sur Les Dix Dernieres annees/?A Donde Ha Ido a Parar Toda la Ayuda? Analisis Detallado del Aumento De la Ayuda Sanitaria En Los Ultimos Diez Anos

Academic journal article Bulletin of the World Health Organization

Where Did All the Aid Go? an In-Depth Analysis of Increased Health Aid Flows over the Past 10 years/Ou Est Allee Toute L'aide Sanitaire? Analyse Approfondie Des Flux Croissants D'aide Sanitaire Sur Les Dix Dernieres annees/?A Donde Ha Ido a Parar Toda la Ayuda? Analisis Detallado del Aumento De la Ayuda Sanitaria En Los Ultimos Diez Anos

Article excerpt

Une traduction en francais de ce resume figure a la fin de l'article. Al final del articulo se facilita una traduccion al espanol.

Introduction

Most assessments of the changes in international health aid over the past 10 years have focused on the fragmented nature of the new global health financing landscape and the health governance challenges created by growing numbers of aid channels and instruments. (1-4)

In the last decade, global health concerns and development priorities, including the health-related Millennium Development Goals (MDGs), have resulted in the mushrooming of new health initiatives targeting single diseases or programmes, many of them with substantial financing capabilities. As a result, concerns have been voiced that spending priorities are increasingly determined at global and regional levels rather than at the recipient country level. Concurrently, concerns about the efficiency of aid delivery have prompted the development community to promote the use of more efficient aid instruments, including general budget support and sector-wide approaches.

While global levels of health aid are clearly rising, it is less clear whether the amount of money available to countries to allocate flexibly, in accordance with their health priorities and health system development needs, is also increasing. With notable exceptions, (5,6) few studies have looked in detail at any of the issues mentioned above or at what official development assistance (ODA) resources for health are being spent on, at which countries are benefiting or at the potential for new resources to contribute to health development and health systems strengthening. This study attempts to answer some of these complex questions using statistical data from the Development Assistance Committee of the Organisation for Economic Co-operation and Development (OECD/DAC).

It should be noted that much of the data reviewed here pre-dates the Paris Declaration on Aid Effectiveness, (7) under which donors committed to provide their aid more coherently and in alignment with country priorities, systems and procedures.

Methods

This analysis focuses on ODA, i.e. grants or loans by governments to developing countries with promotion of economic development and welfare as the main objective. The data come from donor reports to the OECD/DAC. The OECD's Aggregate Aid Statistics and Creditor Reporting System (CRS) are the most reliable sources of aid data. The CRS is the main source used in this analysis, although data series referring to years before 2000 are from the Aggregate Aid Statistics. Part of the analysis focuses on the least developed countries (LDCs), since they are at the centre of global health development efforts.

One limitation of OECD statistics, especially in recent years, is that they do not include funds provided by non-OECD governments such as China and India and by wealthy Middle-Eastern countries. Also excluded are funds provided by private entities such as the Bill & Melinda Gates Foundation. The real magnitude of health aid flows is therefore much higher: The World Bank reported, for example, that in 2006 total development assistance to health, including aid from private organizations, reached US$ 16.7 billion, (8) whereas the CRS recorded only US$ 13.3 billion. In addition, although CRS statistics dating back to 1973 are available, reliable in-depth analysis can only be carried out from 2000 onwards because of the limited coverage of earlier data and changes in reporting guidelines.

The secretariat of the OECD/DAC continuously monitors the quality of aid activity data reported by donors, focusing on the completeness of reporting and its conformity with definitions. The quality of CRS data on commitments for the period 2002-2006, on which this analysis focuses, ranges from good to excellent.

The CRS's classification system, however, does not always perfectly fit some of the development benchmarks --such as the MDGs--against which health ODA resources are measured. …

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