Financing
Has HIV/AIDS displaced other health funding priorities? Evidence from a new dataset of development aid for health
Lordan G, Tang KK, Carmignani F. Soc Sci Med. 2011 Jul 9.
In recent times there has been a sense that HIV control has been attracting a significantly larger portion of donor health funding to the extent that it crowds out funding for other health concerns. Although there is no doubt that HIV has absorbed a large share of development assistance for health, whether HIV is actually diverting funding away from other health concerns has yet to be analyzed fully. To fill this vacuum, this study aims to test if a higher level of HIV funding is related to a displacement in funding for other health concerns, and if yes, to quantify the magnitude of the displacement effect. Specifically, Lordan and colleagues consider whether HIV development assistance for health has displaced i) TB, ii) malaria iii) health sector and 'other' development assistance for health in terms of the dollar amount received for aid. They consider this question within a regression framework controlling for time and recipient heterogeneity. The authors find displacement effects for malaria and health sector funding but not TB. In particular, the displacement effect for malaria is large and worrying.
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Editor’s note: This study of 44 low- and middle-income countries that have a significant burden of HIV, tuberculosis (TB), and malaria, along with a health sector in need of strengthening, assessed the extent of dollar displacement, rather than share displacement, that donor HIV funding may be incurring. This means that it examined changes in the actual amount of aid provided for HIV, TB, malaria, and health sector strengthening, rather than changes in the share of aid devoted specifically to HIV. As we know, the amount of development assistance for health (DAH) devoted to HIV has increased over time. TB has not suffered, perhaps because donors see funding for the two diseases to be complementary. Malaria, killing one million people in 2008 and accounting for 20% of African childhood mortality, clearly ranks highly for donor attention by the criteria of burden of disease. As well, lower per-capita income in high malaria-burden countries suggests less capacity for domestic resource mobilisation for malaria. Yet, this study estimates that for every 1% increase in funds devoted to HIV in a year, there is an 11% decrease the following year in funds devoted to malaria. This rises to 19% when considering only the 29 countries with malaria prevalence above 1% of the population. Aside from the concern about likely ‘crowding out’ of malaria funding by HIV funding, this study suggests that donor commitments are barely medium-term, let along long-term, a factor that is undermining country-led processes for resource allocation planning for both diseases.
