JAMA
June 16, 2015, Vol 313, No. 23
http://jama.jamanetwork.com/issue.aspx

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Scientific Discovery and the Future of Medicine
Science, Medicine, and Society: A View From the Wellcome Trust
Jeremy Farrar, FRS, FRCP, FMedSci, OBE

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Editorial | June 16, 2015
Development Assistance for Health Potential Contribution to the Post-2015 Agenda
Andy Haines, MD, MB, BS1
Author Affiliations
JAMA. 2015;313(23):2328-2330. doi:10.1001/jama.2015.5790.
Despite economic growth in low-income countries, the internal resources available to some governments will be inadequate to support the delivery of health care to their populations for years to come.1 Approximately 150 million people worldwide experience catastrophic expenditure annually to cover out-of-pocket payments for health.1 Despite substantial progress, 6.6 million children who were younger than 5 years died in 2012 and a quarter of all children younger than 5 years were stunted (having an inadequate height or length for age).2 Almost 300 000 women died in 2013 of causes related to pregnancy and childbirth.2 Against this background, the study by Dieleman and colleagues3 in this issue of JAMA makes a substantial contribution to the current understanding of the flow of development assistance for health (DAH) and how these resources can contribute to the achievement of international health goals…

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Special Communication | June 16, 2015
Sources and Focus of Health Development Assistance, 1990–2014
Joseph L. Dieleman, PhD1; Casey Graves, BA1; Elizabeth Johnson, BA1; Tara Templin, BA1; Maxwell Birger, BS1; Hannah Hamavid, BA1; Michael Freeman, MPH2; Katherine Leach-Kemon, MPH1; Lavanya Singh, BS1; Annie Haakenstad, MA1; Christopher J. L. Murray, MD1
Author Affiliations
JAMA. 2015;313(23):2359-2368. doi:10.1001/jama.2015.5825
Abstract
Importance
The governments of high-income countries and private organizations provide billions of dollars to developing countries for health. This type of development assistance can have a critical role in ensuring that life-saving health interventions reach populations in need.
Objectives
To identify the amount of development assistance that countries and organizations provided for health and to determine the health areas that received these funds.
Evidence Review Budget, revenue, and expenditure data on the primary agencies and organizations (n = 38) that provided resources to developing countries (n = 146-183, depending on the year) for health from 1990 through 2014 were collected. For each channel (the international agency or organization that directed the resources toward the implementing institution or government), the source and recipient of the development assistance were determined and redundant accounting of the same dollar, which occurs when channels transfer funds among each other, was removed. This research derived the flow of resources from source to intermediary channel to recipient. Development assistance for health (DAH) was divided into 11 mutually exclusive health focus areas, such that every dollar of development assistance was assigned only 1 health focus area.
Findings
Since 1990, $458.0 billion of development assistance has been provided to maintain or improve health in developing countries. The largest source of funding was the US government, which provided $143.1 billion between 1990 and 2014, including $12.4 billion in 2014. Of resources that originated with the US government, 70.6% were provided through US government agencies, and 41.0% were allocated for human immunodeficiency virus (HIV)/AIDS. The second largest source of development assistance for health was private philanthropic donors, including the Bill and Melinda Gates Foundation and other private foundations, which provided $69.9 billion between 1990 and 2014, including $6.2 billion in 2014. These resources were provided primarily through private foundations and nongovernmental organizations and were allocated for a diverse set of health focus areas. Since 1990, 28.0% of all DAH was allocated for maternal health and newborn and child health; 23.2% for HIV/AIDS, 4.3% for malaria, 2.8% for tuberculosis, and 1.5% for noncommunicable diseases. Between 2000 and 2010, DAH increased 11.3% annually. However, since 2010, total DAH has not increased as substantially.
Conclusions and Relevance
Funding for health in developing countries has increased substantially since 1990, with a focus on HIV/AIDS, maternal health, and newborn and child health. Funding from the US government has played a substantial role in this expansion. Funding for noncommunicable diseases has been limited. Understanding how funding patterns have changed across time and the priorities of sources of international funding across distinct channels, recipients, and health focus areas may help identify where funding gaps persist and where cost-effective interventions could save lives.