HIV This Week

Sridhar D, Batniji R. Misfinancing global health: a case for transparency in disbursements and decision making. Lancet 2008; 27;372(9644):1185-91.

To address the gap between health investments and financial flows worldwide, Sridhar and Batniji identified the patterns in allocation of funds by the four largest donors—ie, the World Bank, Bill & Melinda Gates Foundation, the US Government, and the Global Fund to Fight HIV/AIDS, Tuberculosis and Malaria—in 2005. They created a disbursement database with information gathered from the annual reports and budgets. Funding per death varied widely according to type of disease—eg, US$1029.10 for AIDS to $3.21 for non-communicable diseases. The World Bank, US Government, and Global Fund provided more than 98% of their funds to service delivery, whereas Bill & Melinda Gates Foundation gave most of its funds to research. Bill & Melinda Gates Foundation grants in 2005 were given largely to private research organisations, universities, and civil societies in rich countries, whereas the US Government and Global Fund primarily disbursed grants to sub-Saharan Africa. Publicly available data for global health disbursements is incomplete and not standardised. Continued attention is needed to develop country ownership, particularly in planning and priority setting.

Edtiors’ note: The four major global health donors analysed here account for only a third of all donor funding for global health. Nonetheless, they are big players and this study of their comparative mandates and disbursements is revealing. Data on their disbursements are of variable quality, disease burden estimates are imprecise, and their decision-making processes were not assessed. With global health governance being a patchwork of donors, UN agencies, governments, civil society organisations, and the private sector, much remains to be done to implement the Paris Declaration which envisages decision-making based on the articulated needs of developing countries.