Is adequate health development assistance reaching central and eastern Europe?

The health of people in many countries of central and eastern Europe and the Commonwealth of Independent States (CEE-CIS) has declined in the past ten years due to social and economic instability. Is sufficient development assistance for health being sent to these countries compared to other countries with similar levels of life expectancy and national health spending?

A country’s socialand economic development can be affected significantly by internationaldevelopment assistance. At United Nations conferences, the importance ofofficial development assistance (ODA) has repeatedly been stressed. MillenniumDevelopment Goal Eight appeals to the donor community to increase its aidefforts.

The health systemsof much of CEE-CIS have been affected by the past decade’s political upheavaland people’s health has suffered as a result. In some of the former SovietUnion countries, life expectancy has deteriorated in recent years. Despitethis, most development assistance for health is destined for “traditional”developing countries, especially in sub-Saharan Africa. In contrast, little aidhas been earmarked for CEE-CIS countries.

A study by the WHOEuropean Office for Investment for Health and Development, the London School ofHygiene and Tropical Medicine, UK, and the Harvard Center for Population andDevelopment Studies, USA looks at whether international development assistancefor health received by the countries of CEE-CIS matches the health needs andfinancial resources of the region. It considers why development assistanceallocation is so low with regards to health indicators and whether less health assistanceis given to countries with higher levels of health expenditure.

The study foundthat:

• The CEE-CIS region received the secondhighest total official development assistance (ODA) per capita of allregions, and received more ODA than other countries with similar percapita incomes.  
• However, ODA for health – US$0.34 percapita or only 1.7 percent of total ODA – was low for CEE-CIS countries in1997-99 compared to the average of US$1 or 9 percent of total ODA receivedglobally.
• Development assistance for health wasalmost non-existent in some CEE-CIS countries, the average for 15 of the27 countries being less than 0.1 percent of total ODA in 1997-99.
• Most CEE-CIS countries received lessdevelopment assistance for health than other countries with similar childdeath rates, life expectancy levels and national health spending.

In CEE-CIScountries non-communicable diseases play a greater role than communicablediseases in the burden of deaths and disease. Traditional developing countriesare usually plagued by high levels of communicable diseases and high infant andchild deaths. The findings of this study add to the view that non-communicablediseases are being overlooked globally when it comes to development assistancefor health.

In drawingimplications for policy, the study found that:

• a greater effort is needed to reducethe burden of ill health in the CEE-CIS region
• as poor health in the CEE-CIS region haspossible implications for the economic and social stability of Europe, andas many of the CEE-CIS countries face severe resource shortages, there isa strong argument for effective international assistance for health in thesecountries.