- Improved Aid for Better Health – Recommendations from the Busan Health Working Group For the HLF-4 and beyond 29 September 2011
The Importance of Health Aid Good health is vital to human welfare and to continued economic and social development. Realisation of the universal human right to health is inextricably linked to the amount and the effectiveness of aid. Most aid recipient governments are doing their best to achieve universal access to health, but require external funding to fill gaps between funding needs and their own resources. For example, in Tanzania foreign aid represents nearly 40% of the health sector budget.1 Donors have been increasingly filling health sector funding gaps: Development assistance for health grew considerably over the last two decades, from $6 billion in 1990 to $22 billion in 20072. However, an additional US$36-45 billion is required annually to meet the health-related Millennium Development Goals (MDGs) by 20153. These include MDG 4: Reduce child mortality; MDG 5: Improve maternal health and achieve universal access to reproductive health; and MDG 6: Combat HIV/AIDS, malaria and other major diseases. Currently the bulk of the health funding is targeted at HIV/AIDS, Malaria and infectious disease control, although funding for HIV is currently decreasing4. Sectors such as family planning have seen a decline in funding levels, despite the increase in numbers of women with an unmet need for family planning.5 Moreover, additional funding is required for other key social sectors that impact on human health such as nutrition, water and sanitation, gender equality and primary education.
Aid Effectiveness in the Health Sector Health is at the forefront of the debate on what aid effectiveness means from a sector perspective. In the 1990s donors and governments created Sector-Wide Approaches (SWAps) to improve harmonization, predictability of aid and donor alignment behind national health programmes. In recognition of the need to address the growing complexities of aid programmes, in 2005 the international community endorsed the Paris Declaration on Aid Effectiveness, and the subsequent 2008 Accra Agenda for Action. In the health sector, efforts to promote donor coordination, alignment, and country ownership have resulted in a number of initiatives such as the International Health Partnership and related initiatives (IHP+)6. While donors have made efforts towards aid effectiveness in the health sector, several problems remain. The challenges are complex and include insufficient funding, weak links between investments and health outcomes, and a lack of strong political will to invest in the health sector by Ministries of Finance in aid recipient countries. These challenges have been compounded by increasing complexity in the number of external actors in the health sector and a proliferation of different financing mechanisms, resulting in high transaction costs for Ministries of Health. Insufficient attention to equity and financial sustainability are also persistent problems in the sector.
1
Koenig, S. and R. Rosenquist. 2010. Institute for Health Metrics and Evaluation, 2011. 3 Taskforce on Innovative International Financing for Health Systems, 2009. 4 Kates et al. 2011. 5 OECD, QWIDS, accessed 6 September 2011. 6 Other examples of efforts to improve aid effectiveness in sectors that impact health outcomes include the Sanitation and Water for All partnership, and Comprehensive Africa Agriculture Development Programme. 2
1