Setting the right priorities for health development: donor responsibilities

Health has emerged as a key area of development as donors increasingly recognise the link between poor health and poverty. This has been most apparent in the fight against HIV/AIDS. Setting the right priority is still crucial in situations where available resources fall far short of actual health needs.

The World Health Organization estimates the annual cost of essential health care in low-income countries to be US$12 per person. Although the Global Fund to Fight AIDS, Tuberculosis and Malaria’s has supported improvements in the health sector, an extra US$7–10 billion per year is still required just to help fight communicable diseases. Research supported by the Organisation for Economic Co-operation and Development (OECD) examines this gap between needs and resources, and looks at the decisions behind how priorities are set in global health development.

When giving assistance, donors consider not only the priorities that recipient countries set, but also how quickly the disease spreads, the ability of poor countries to cope on their own, the existence of cost-effective interventions, the characteristics of the victims of disease and the prevalence and risk of infection in donors’ own countries. These apply to all categories and not just to infectious diseases.

The research compares development assistance for the HIV/AIDS and population sectors of global health development against the assistance given to other areas of both communicable and non-communicable disease, such as maternal and reproductive health, and nutrition.

The research shows:

• HIV/AIDS is allocated a much higher share of assistance than its actual percentage of the overall burden of disease.
• If HIV/AIDS is excluded, health assistance is actually decreasing as a share of total overseas development assistance (ODA), in many middle and low-income countries.
• Country priorities in health do not appear to match the allocation of ODA.
• The increase in non-communicable diseases will continue in developing countries as their population age, income levels rise and increases in tobacco use begin to take affect.
• Despite cost-effective ways to improve poor nutrition being available, these receive little support.

These patterns reflect donor beliefs that HIV/AIDS is a priority for funding because, if not addressed now, the epidemic will be even worse in the future. This is at the cost of other areas of disease and supports concerns that international assistance does not reflect priorities in recipient countries.

The report suggests that donors should:

• address the dangers of distorting health sector development through an overspending on HIV/AIDS
• consider a replacement method for measuring the impact of disease, as the current prioritisation tool does not clearly explain the way priorities are set
• improve the preparation of country Poverty Reduction Strategies so they indicate how health and disease are managed in those countries
• devise frameworks for setting priorities in which the impact of disease is only one of the factors
• be aware that strategies targeted towards poor people may not reflect health priorities but rather a country’s ability to produce a strategy conforming to international demands.

Source(s):
‘Priorities in Global Assistance for Health, AIDS and Population (HAP)’, OECD Development Centre, Working Paper 244, by Landis MacKellar, June 2005 Full document.
‘Priorities in Global Assistance for Health, AIDS and Population’, Population and Development Review, Vol. 31, No. 2, pp.293-312, by Landis MacKellar, June 2005 Full document.

Funded by: Organisation for Economic Co-operation and Development

id21 Research Highlight: 29 March 2006

Further Information:
Landis MacKellar
Development Centre
Organisation for Economic Co-operation and Development (OECD)
2 rue André Pascal
75775 Paris
Cedex 16, France

Tel: +33 14 5248200
Fax: +33 14 5248500
Contact the contributor: dev.contact@oecd.org

Organisation for Economic Co-operation and Development (OECD)

Other related links:
'How can the real scale of the HIV/AIDS pandemic be measured?'

'Can it be done? Prospects for improving health of the global poor'

'Counting the cost of HIV in Southern Africa'

Global health priorities – priorities of the wealthy?

The Global Fund to fight Aids Tuberculosis and Malaria