HIV This Week

Shiffman J. Has donor prioritisation of HIV/AIDS displaced aid for other health issues? Health Policy Plan. 2008 Mar;23(2):95-100.

Advocates for many developing-world health and population issues have expressed concern that the high level of donor attention to HIV is displacing funding for their own concerns. Even organizations dedicated to HIV prevention and treatment have raised this issue. However, the issue of donor displacement has not been evaluated empirically. This paper attempts to do so by considering donor funding for four historically prominent health agendas - HIV, population, health sector development, and infectious disease control - over the years 1992 to 2005. The paper employs funding data from the Organization for Economic Cooperation and Development's (OECD) Development Assistance Committee, supplemented by data from other sources. Several trends indicate possible displacement effects, including HIV's rapidly growing share of total health aid, a concurrent global stagnation in population aid, the priority HIV control receives in US funding, and HIV aid levels in several sub-Saharan African states that approximate or exceed the entirety of their national health budgets. On the other hand, aggregate donor funding for health and population quadrupled between 1992 and 2005, allowing for funding growth for some health issues even as HIV acquired an increasingly prominent place in donor health agendas. Overall, the evidence indicates that displacement is likely occurring, but that aggregate increases in global health aid may have mitigated some of the crowding-out effects.

Editors’ note: Although this study considers only aggregate donor funding, does not evaluate national health funding in depth, and does not account for factors influencing funding for other health issues, such as disease burden and effectiveness of advocacy, it will definitely start you thinking. We can only imagine how funding flows might have evolved in a world without AIDS, the so-called ‘counterfactual’ of which economists speak. More in-depth studies are needed to examine the politics of aid provision in high-income countries, interactions among donors themselves, and dynamics in low- and middle-income countries in the context of donor harmonization initiatives and the Three Ones principles that place countries squarely in the driver’s seat.