Where Does the Good Go?

The Lancet, an online and print health journal, has just published a collective report documenting the state of development aid for health (DAH). The report, which contains many in-depth graphs and charts, has some very thought-provoking findings.

While funding for global health initiatives has increased from $5.6 billion in 1990 to $21.8 billion in 2007, the percentage of DAH mobilized by UN agencies decreased from 32·3% to 14·0% in that same timespan. Even the World Bank, what some have considered the more recent replacement for the World Health Organization’s prominence in global health, has lost much of its share in global DAH. It has fallen from a high of 21.7% in 2000 down to 7.2% in 2007.

So what has replaced these international organizations? The study found that The Global Fund, GAVI (Global Alliance for Vaccines and Immunization), and the Bill and Melinda Gates foundation have all increased their percentage DAH’s. In 2002, The Global Fund and GAVI constituted less than 1% of total DAH and have now scaled up to 8·3% and 4·2%, respectively. The Bill and Melinda Gates Foundation, as of 2007, has a 3.9% share of total DAH.

One other important trend the report found was a large shift in the NGO sector. From 1990 to 2006, NGO resource share increased from 13·1% of DAH to 24·9%.

These trends imply that global health initiatives are slowly becoming more and more privatized. This paradigm shift will change the position and status of U.N. organizations and the World Bank. Slowly but surely these organizations are being downgraded from trusted bridges between scientific and governmental sectors into players scrambling just like NGO’s in the crazy world of global health funding.