Development assistance for health: critiques, proposals and prospects for change

Abstract

After a 'golden age' of extraordinary growth in the level of development assistance for health (DAH) since 1990, funding seems to have reached a plateau. With the launch of the Sustainable Development Goals, debate has intensified regarding what international financing for health should look like in the post-2015 era. In this review paper, we offer a systematic overview of problems and proposals for change. Major critiques of the current DAH system include: that the total volume of financing is inadequate; financial flows are volatile and uncertain; DAH may not result in additional resources for health; too small a proportion of DAH is transferred to recipient countries; inappropriate priority setting; inadequate coordination; weak mechanisms for accountability; and disagreement on the rationale for DAH. Proposals to address these critiques include: financing-oriented proposals to address insufficient levels and high volatility of DAH; governance-oriented proposals to address concerns regarding additionality, proportions reaching countries, priority setting, coordination and accountability; and proposals that reach beyond the existing DAH system. We conclude with a discussion of prospects for change.

Towards a coherent global framework for health financing: recommendations and recent developments

“…This initiative demonstrated the impact of going beyond gross national product GNI per capita and considering countries' health needs and governments' fiscal capacity, and it recommended donors to take these factors into account when allocating funds. The need for a multi-dimensional set of allocation criteria has also recently been stressed by many others (Burgett et al, 2016), and is thoroughly discussed in this special issue (Moon & Omole, 2017 and three papers by Ottersen et al in this series).…”

Distributing development assistance for health: simulating the implications of 11 criteria

“…An understanding of the implications of different candidate criteria is also important for other stakeholders and the broader community when debating how DAH should be allocated across countries. A good understanding of allocation criteria is also central to the many new global financing mechanisms that have been proposed (Ooms et al, 2006;Consultative Expert Working Group, 2012;Moon and Omole, 2013;Gostin, 2014).…”

Global health financing: Priority to poor people or poor countries?

“…One particularly important category of GPGHs concerns widely disseminated knowledge and information (Kaul et al 1999;Moon et al 2013). This category includes, for example, research findings on the causes of disease and effective interventions.…”

“…Another important category of GPGHs is positive normative guidance and regulation (Kaul et al 1999;Moon et al 2013 There are numerous other important examples, and the GPGHs on which the global community decides to focus should be the outcome of a careful debate.…”

“…However, theory suggests that the absence of mechanisms to ensure cooperation leads to underprovision, and such mechanisms are scarce at the global level. Quite apart from theory, there is also a widespread recognition that the current level of financing is wholly insufficient and that GPGHs are grossly undersupplied (Kaul et al 1999;Moon et al 2013;Blanchet et al 2014). …”