The Great Aid-Shifting Game

Donor money for public health programs should support domestic funding for such efforts, not replace it. If a country faces a significant public health crisis, its government should be leading the response. That includes deciding how to spend the appropriate domestic resources. Right?

Well, a new study says that's not exactly happening in some sub-Saharan African countries.

Instead, as they receive more development money, some governments in sub-Saharan Africa channel less domestic resources into public health programs, according to a study from the Lancet. Most alarming? The greatest reductions in health spending on a national level take place in sub-Saharan African countries wrestling with the largest HIV/AIDS epidemics — whose governments, in turn, were also receiving the most aid to deal with health issues.

The global aid community has responded to the study with a resounding, 'Duh.' Richard Feachem, the former executive director of the Global Fund to Fight AIDS, Tuberculosis and Malaria, told the Seattle Times, for instance, that everyone knew budget shifting was going on. As aid for health programs rolled in, governments moved their own funds to other programs.

That shouldn't be acceptable.

In the background to their study, the authors note that the money governments spend out of their own pockets on health "is an important indicator of a government's commitment to the health of its people, and is essential for the sustainability of health programmes." Both points are critical, especially in the lingering aftermath of a global recession.

Though international health aid has tripled over the past 10 years, according to the Times story, reaching $22 billion in 2007, there is still anxiety that the recession will cause the bottom to fall out of donor funding. I've already written about concerns raised by the 2.6% increase in global health spending from the Obama administration, which was far less than anticipated. The governments singled out in this survey have to take some responsibility for the situation and shore up their national health programs with domestic funds.

The Lancet did publish some caveats to the research, chief among them the fact that there are major inconsistencies in how governments track their health spending. And the larger point of the study was that what's happening in some sub-Saharan African countries isn't being imitated throughout the rest of the world. Indeed, overall domestic spending on health in developing countries doubled over the last 12 years, hitting $18 billion in 2006.

Limited budgets force governments to make choices. But in countries facing severe public health epidemics, funding health programming should be at the top of that list. What's critical, as I've advocated before, is picking the most effective programs and instituting rigid monitoring to ensure that the money is being used effectively. Donor aid can be an important supplement to domestic funding, and in some cases, it can temporarily free up cash to spend on other critical needs. But it shouldn't prompt significant shifts in budget allocations. And definitely not in countries facing major HIV epidemics.

Photo Credit: margaridaperola