The Rationale for Rethinking Global Health Financing

Background – Global health financing in the form of development assistance for health (DAH) has significant effects on the health of people worldwide (1). Several studies have reported that DAH may be poorly aligned with national health priorities (2). This study aims to investigate the global health financing flows in the context of the legitimacy of philanthropic donors; alignment, and sufficiency of DAH; and its agenda distortion effects to answer the question – Is DAH sufficient, and aligned with disease burden and country needs? If not, what are the policy implications?Methods – Alignment was studied by comparing DALYs with the amount of DAH allocated by region and health focus area using secondary data analysis. Sufficiency was studied by adopting the methodology used by Ooms et al (3). A literature review was conducted to study the legitimacy and agenda distortion effects of DAH and the proposed policy recommendations.Results – The allocation of DAH was found to be misaligned by region and health focus area. For instance, Sub-Saharan Africa suffered 515 million DALYs and received 10 billion USD in DAH whereas South Asia, Southeast East Asia and the Oceania region suffered 595 million DALYs and received 1.6 billion USD which was 6 times less despite having more disease burden. HIV/AIDS caused a total of 56 million DALYs (2.2%) worldwide and received 9.3 billion DAH (22.98%) whereas NCDs caused 1.6 billion DALYs (64%) and received 850 million USD in DAH (2.1%). DAH was found to be insufficient and the deficit was calculated to be 41 billion USD.Conclusion – DAH exerts significant influence on the health agenda which is not in alignment with long-term recipient country priorities. Hence, this study recommends a refocus on national health financing and country ownership of agenda setting with DAH playing an additive role.