Financial Flows

In the years leading up to the current global economic downturn, global resources for improving health grew rapidly in low- and middle-income countries. In addition to bilateral agencies, multilateral organizations, and development banks that previously dominated the international aid scene, several new global health players have emerged, including the Bill & Melinda Gates Foundation, the GAVI Alliance, and the Global Fund to Fight AIDS, Tuberculosis, and Malaria.

One of IHME’s initial goals was to design a research strategy for tracking these different financial streams to arrive at an overall estimate of development assistance for health (DAH) from 1990 to the present. Now, in addition to establishing estimates of aggregate flows, we are looking at the composition of resources that are relevant to policymaking. And we are examining whether the distribution of global health resources reflects current global health priorities by classifying resources according to their disease focus, the function of the health system that they attempt to strengthen, the type of input, and the target population.

IHME’s work on financial flows also includes tracking national public expenditure, focusing on the money spent by local and national governments on health. Our researchers, in collaboration with the World Bank and World Health Organization, have examined public budget information to analyze how much money governments allocate to health, how the health sector budgets have changed over time, and how changes in government spending on health relate to incoming aid for health from external sources. Additionally, we have looked at how much money for health comes directly from the government’s national budget versus how much the government receives from an external funder to spend on health or other sectors. Understanding the impact of development assistance on national health spending is particularly important to funders. IHME’s goal is to produce results that will illuminate the intricacies of this relationship.

Major activities in Financial Flows:

Analyze development assistance for health from 1990 to 2007, with updates in future years:

We are tracking financial disbursements and in-kind contributions to improve health and health systems in low- and middle-income countries channeled via institutions whose primary purpose is development assistance. Integrating data from a diverse set of sources, IHME published its first report, Financing Global Health 2009: Tracking Development Assistance for Health, in July 2009. IHME will continue to update the series annually, with the next report expected to be published in summer 2010.

Undertake subgroup analyses of diseases, systems, budget support, and sector-specific support:

Using data we collected for the analysis of total development assistance for health, we are conducting subgroup analyses to take a closer look at how funds are spent, such as examining health resource allocation by disease, how much is spent on general budget support, and how nonhealth sectors are affected.

Assess donor transparency and accountability:

Timely and dependable information on funds from all major donors is an essential element of evidence-based policymaking. It is also necessary for monitoring whether donors are honoring their commitments, to increase coordination between donors, and to foster greater transparency in aid reporting. Unfortunately, existing data systems lack the transparency needed for providing sufficiently detailed and timely analysis. IHME will assess the transparency of development aid and activity reporting systems and contribute to ongoing efforts to improve their quality.

Compile and analyze government health expenditure data; establish international aid impact on national health spending:

IHME has compiled a dataset from various sources, including the WHO, IMF, and country reports, of government health expenditure and is analyzing the effect of external resources on national health budgets. This is to determine how development assistance for health may affect the amount a government spends from its own resources on health.

Improve time series data on government health spending:

We are working to improve time series data on government health spending and total spending, drawing upon country budgets, audited financial statements, and existing data reporting systems. Where data are missing, we are developing the most accurate and reliable methods for filling in the gaps to produce as complete a set of time series budget data as possible.

Develop methods for forecasting health expenditures:

To better understand trends in development assistance for health and government expenditures for health, IHME researchers are developing novel methods to predict expenditures on health before the data are available. These predictions are critical in understanding how the recession has affected health spending.

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