Aid distribution inadequate in many hard-hit countries

Global government assistance and other economic aid in response to Covid-19 amounted to $13.7 billion in 2020, including $12.3 billion in new health spending, according to a report from the Global Burden of Disease 2020 Health Financing Collaborator Network.

A total of $54.8 billion in government and other development assistance for health was distributed worldwide in 2020 during the first year of the pandemic, compared to $40.4 billion in development assistance spending during 2019.

The report, which was funded by the Bill & Melinda Gates Foundation, highlighted significant geographical inequities in economic aid disbursements—countries with the highest Covid-19 burden often did not receive sufficient aid. Latin America and the Caribbean, for example, received just 8% of the total Covid-19 development assistance for health, despite having 39% of deaths from the disease in low- and middle-income countries in 2020.

The report exploring current and predicted future public assistance expenditures related to Covid-19, published this week in The Lancet, predicted that while global health spending will continue to grow, economic aid will remain unequally distributed.

“Much more money is needed to fully address the effects of the pandemic in most low-income and middle-income countries, along with access to key tools such as vaccines,” wrote Angela Micah, of the University of Washington, Seattle, Institute for Health Metrics and Evaluation, and colleagues.

“Moreover, long-term projections suggest that health inequalities are likely to persist and that international efforts to invest in global public goods related to global pandemic preparedness are essential. Resources are needed urgently to mitigate the loss associated with the Covid-19 pandemic and fund systems that can prevent and respond quicker to the next global health crisis.”

The researchers estimated domestic health spending and development assistance for health to generate total health-sector spending estimates for 204 countries and territories by leveraging data from the WHO Global Health Expenditure Database to produce estimates of domestic health spending.

Project-level disbursement data from the major international development agencies’ online databases and annual financial statements and reports for information on income sources were used for the estimate of developmental assistance, and to calculate the estimates for 2020, the researchers noted that they culled “project data on commitments and disbursements from a broader set of databases including the UN Office of Humanitarian Assistance Financial Tracking Service and the International Aid Transparency Initiative.”

Global health spending in 2019 was $8.8 trillion (95% uncertainty interval [UI] 8.7-8.8) or $1,132 (1119-1143) per person, with variation both within and across income groups and geographic regions.

“Of this total, $40.4 billion (0.5%, 95% UI 0.5-0.5) was development assistance for health provided to low-income and middle-income countries, which made up 24.6% (UI 24.0-25.1) of total spending in low-income countries,” the researchers wrote.

“We estimate that $54.8 billion in development assistance for health was disbursed in 2020. Of this, $13.7 billion was targeted toward the Covid-19 health response. $12.3 billion was newly committed and $1.4 billion was repurposed from existing health projects. $3.1 billion (22.4%) of the funds focused on country-level coordination and $2.4 billion (17.9%) was for supply chain and logistics,” they added.

Latin America received just $714.4 million (7·7%) of Covid-19 development assistance for health. This, the study authors noted, “despite this region reporting 34.3% of total recorded Covid-19 deaths in low-income or middle-income countries in 2020. Spending on health was projected to rise to $1,519 (1448–1591) per person in 2050, although spending across countries is expected to remain varied.”

A significant study limitation cited by the researchers was the inability to account for the uncertainties created by Covid-19 or the occurrence of another Covid-19-like pandemic.

In commentary published with the report, Osondu Ogbuoji of the Duke University Global Health Institute, Durham, North Carolina, and colleagues, noted that given these and other limitations, the report findings should be interpreted with caution.

Covid-19 might trigger a new age of sustained increase in development assistance for health similar to HIV between 2002 and 2010, when development assistance for health increased by 11.2% per year and annual development assistance for health tripled between 2001 and 2010,” they wrote.

“Conversely, slow economic growth in donor countries coupled with rising nationalism and donor fatigue might lead to decreased development assistance for health. Indeed, the announcement by the UK Government to cut bilateral aid to 102 countries in the middle of the pandemic shows how little is known about donor-country responses to the pandemic,” the editorialists wrote.

They added that the modeling used to estimate future government health expenditures and development assistance relied heavily on projections of the gross domestic product (GDP).

“As a result, the models fail to capture important political shifts created by crises such as pandemics that could influence health spending overall and above the impact of the GDP,” they wrote, further noting that several countries increased investments in health related to the GDP following national crises, including China (SARS-CoV-1), Rwanda (genocide), and Thailand (Asian financial crisis).

Ogbuoji et al noted that it is not clear that the modeling utilized by the researchers “sufficiently captured the changing frequency of outbreaks, the differential impact on the economy, and the subsequent effect on development assistance for health.”

“Taken together, these concerns illustrate the potential impact of Covid-19 on future government health expenditure and development assistance for health,” they wrote. “The ultimate direction and magnitude of the impact is not certain and will depend on which of the counteracting forces prevail. It is therefore impossible to say exactly how health spending and development assistance for health will change over the next 30 years. Although these projections reflect the current state of knowledge, they might quickly become outdated as situations change and more evidence becomes available.”

  1. Global government assistance and other economic aid in response to Covid-19 amounted to $13.7 billion in 2020, including $12.3 billion in new health spending.

  2. A total of $54.8 billion in government and other development assistance for health was distributed worldwide in 2020 during the first year of the pandemic, compared to $40.4 billion in development assistance spending during 2019.

Salynn Boyles, Contributing Writer, BreakingMED™

This research was funded by the Bill & Melinda Gates Foundation.

The study authors and the editorialists had no disclosures.

Cat ID: 190

Topic ID: 79,190,730,933,190,926,192,927,150,151,928,925,934