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Health aid may be allocated efficiently, but not always optimally

malaria bed net

Foreign aid to the public-health sectors of developing countries often appears to be allocated backwards: The global burden of non-communicable diseases such as diabetes or heart disease is enormous - yet these disorders receive little health aid.

By comparison, the global burden of HIV is much smaller, yet it receives more health aid than any other single disease.

An alignment in health aid could best be improved by focusing on malaria and TB, especially where addressing those diseases is highly cost effective

So will a wholesale reversal in health aid priorities improve global health? The answer, according to a new study by Stanford researchers, is that if the goal is to maximize the health benefits from each donor dollar, health aid is actually allocated pretty well.

Still, reallocating foreign aid to step up the fight against malaria and tuberculosis (TB) could lead to greater overall health improvements in developing nations. And it could be done without spending more money, the researchers show.

For their work, Eran Bendavid, MD, an assistant professor in the Department of Medicine and a core faculty member at the Center for Health Policy and Center for Primary Care and Outcomes Research, and three researchers focused on 20 countries that received the greatest total amount of aid between 2008 and 2011, a period of historically unprecedented growth in health aid. The 20 countries - from Afghanistan to Zambia - received $58 billion out of the $103.2 billion in recorded health aid disbursements to 170 countries between 2001 and 2011.

"What we found, somewhat to our surprise, is that in nearly all countries, more aid was flowing to finance priorities with more cost-effective options," Bendavid, said in an interview. "That is partly because more aid was flowing to the treatment and prevention of infectious diseases such as HIV and malaria, and their management can be relatively inexpensive."

Bendavid, an infectious disease physician, added: "Even though the burden of non-communicable diseases is high and growing, addressing chronic conditions such as diabetes and heart disease is, broadly, more costly than the unfinished infectious disease agenda."

In their paper, Bendavid and his co-authors write that the "data suggest that [an alignment in health aid] could best be improved by focusing on malaria and TB, especially where addressing those diseases is highly cost effective." Gains would come from taking some aid earmarked for HIV or maternal, newborn or child health, and putting it toward programs to treat these two disorders, they say.

But it's also crucial, they conclude, to further study the consequences of realignment of donor funds.

This paper appears in the July issue of Health Affairs.

Beth Duff-Brown is communications manager for the Center for Health Policy and Center for Primary and Outcomes Research.

Previously: Foreign health care aid delivers the goods and Foreign aid for health extends life, saves children, Stanford study finds
Photo, of a mother and son under an insecticide-treated bed net in Tanzania, by the Gates Foundation

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