WHO Expert Group on R

1
WHO Expert Group on RD Financing Geneva, 12-14
January 2009 Tracking Financial
Resources for Health RD Stephen
Matlin Executive Director Global Forum for
Health Research Geneva
2
The spectrum of health research for development
Biomedical research
Health policy and systems research
Social sciences and behavioural research
Operational research
Understanding the biological nature of diseases
creating products to prevent or treat disease
states
Understanding how to test, scale-up and follow
through the introduction of interventions and
optimize their benefits
Innovation
Impact
3

• Resources for health RD are situated in the
• domains of
• development cooperation (ODA)
• 2. health
• 3. research

4

• Targets commitments and aspirations
• e.g. Commitments
• 1. Each economically advanced country will
  progressively increase its official development
  assistance to the developing countries and will
  exert its best efforts to reach a minimum net
  amount of 0.7 per cent of its gross national
  product at market prices by the middle of the
  decade.
• Adopted UN General Assembly 1970
• Reinforced Monterrey Consensus on Financing for
  Development 2002
• Timetables by 2015, set by many EU countries
  since 2002
• Ministers of ST of 20 African countries
  reaffirmed their commitment to increasing public
  spending on RD to at least 1 of GDP within five
  years.
• Adopted First NEPAD Ministerial Conference on
  ST
• Declaration and Outline of a Plan of Action
  adopted in
• Johannesburg on 3-7 November 2003

5
Targets commitments and aspirations e.g.
Aspirations (? Commitments) 1. LMICs should aim
to spend 2 of their government health budgets on
health research and research capacity
strengthening this should be complemented by
donors committing 5 of their health aid
similarly. Recommended Commission on Health
Research for Development 1990 Reinforced
Mexico Ministerial Summit on Health Research
2004 and WHA 2005 Committed We, ministers
of health and heads of delegation of the
African countries, meeting in Algiers on 26
June 2008 for the Ministerial Conference on
Research for Health in Africa commit ourselves
to launching before the end of 2009 the actions
that follow j. Allocate at least 2 of
national health expenditures and at least 5 of
health external project and programme aid to
research and research capacity building and
invest more on research aimed at improving
health systems.
6
Targets commitments and aspirations e.g.
Aspirations 2. The Ministers of Health and Heads
of Delegation (of 14 African countries)
urge 9.iii Global Health Initiatives and
development agencies to devote at least 5 of
their overall health investment portfolio to
support research capacity of countries,
dissemination of research findings and management
of knowledge. Recommended Accra Communiqué High
Level Ministerial Meeting on Health Research
for Disease Control and Development. Accra,
Ghana 17th June 2006
7
Report Card for RD for Health A All
Countries A-1 National RD total investment as a
GDP A-2 National RD for health as GDP
A-3 National RD for health as national health
investments A-4 National RD for health as
total RD B High-income countries B-1 Gap
between actual ODA and commitment to invest 0.7
of GNI on ODA B-2 Gap between actual annual
increase in ODA and commitment to double aid
between 2005 and 2010 - an extra 50 billion
worldwide and 25 billion for Africa B-3 Gap
between actual ODA investments in RD for health
and target to invest 5 of health ODA in RD for
health C Low- and Middle-income Countries
C-1 Gap between actual investments in health and
target to spend 15 of domestic public spending
on health C-2 Gap between actual investments in
RD for health and target to spend 2 of national
health budgets on health research D Global
Health Initiatives and development
agencies D-1 Gap between actual investments and
target to invest 5 of overall health investment
portfolios of Global Health Initiatives and
development agencies to support research capacity
of countries, dissemination of research findings,
and management of knowledge.
8
1. Development cooperation (ODA)

• Targets
• 1970 UN, 2002 Monterrey
• 0.7 of GNP/GNI on ODA
• 2005 Gleneagles G8 Summit
• Doubling of aid by 2010
• an extra 50 billion per year worldwide and
• 25 billion per year for Africa, compared with
  2004

9
ODA spending by country
10
Development cooperation (ODA)
Central government
Bilateral ODA
Multilateral ODA
Other government agencies (host
country, transitional developing countries)
UN Agencies The World Bank Group Regional
Development Banks EC
Ministries Development cooperation
agencies Specialized research agencies
Voluntary contributions
Universities Research institutions Research
councils Nongovernmental organizations Foundations
/charities/trusts Companies Partnerships/Initiativ
es Public-private partnerships
11
DAC members total ODA from 1980 in 2006 US and
as a share of GNI
Global Forum for Health Research, Monitoring
Financial Flows for Health Research, 2008
12
OECD 2005 www.oecd.org/dataoecd/34/26/36418606.pd
f
13
Comparison of 2005 ODA to the 0.7 of GNI target,
for the G7 Countries
Global Forum for Health Research, Monitoring
Financial Flows for Health Research, 2008
14
Quality-adjusted aid
Commitment to Development Index 2007
www.cgdev.org
15
Aid flows
2002 58 billion total aid flows from rich
countries to poor ones 2000 - 2002 new aid
project commitments Mozambique 1,413 India
1,339 China 1,328 Tanzania 1,371 2003 Tanzania
declared a four-month mission holiday,
receiving only the most urgent visits by donors

Foreign Policy, Ranking the Rich 2004
16
Bilateral Donor Support to Tanzania, 2000-2002

Foreign Policy, Ranking the Rich 2004
17
Paris Declaration on Aid EffectivenessOwnership,
Harmonisation, Alignment, Results and Mutual
AccountabilityHigh Level Forum, Paris 28
February 2 March 2005

• We reaffirm the commitments made at Rome to
  harmonise and align aid delivery.
• especially in the following areas
• Strengthening partner countries national
  development strategies and associated operational
  frameworks
• Increasing alignment of aid with partner
  countries priorities, systems and procedures and
  helping to strengthen their capacities.
• iii. Enhancing donors and partner countries
  respective accountability to their citizens and
  parliaments for their development policies,
  strategies and performance.
• iv. Eliminating duplication of efforts and
  rationalising donor activities to make them as
  cost-effective as possible.
• v. Reforming and simplifying donor policies and
  procedures to encourage collaborative behaviour
  and progressive alignment with partner countries
  priorities, systems and procedures.
• vi. Defining measures and standards of
  performance and accountability of partner country
  systems in public financial management,
  procurement, fiduciary safeguards and
  environmental assessments, in line with broadly
  accepted good practices and their quick and
  widespread application.

www.oecd.org/dataoecd/11/41/34428351.pdf
18
Economist 11 October 2008
19
UN chief urges donors to honour aid pledges
despite financial crisis UN Secretary-General
Ban Ki-moon expressed deep concern on Tuesday at
the continuing financial crisis, urging donor
countries to honour their commitments to helping
the world's poorest people despite difficulties
caused by the crisis.Echoing a similar concern
raised by World Bank President Robert Zoellick,
Ban stressed that leaders of the Group of Eight
industrialized countries had committed to
providing annually 50 billion U.S. dollars for
the purpose of helping developing countries in
the 2005 Gleneagles summit. "Now because of all
this changing prices, it has gone up to at least
62 billion dollars now," Ban said. "First of all,
G8 countries should implement their
commitment."Xinhua, 8 October 2008
20
What happens to aid following financial crises
David Roodman, Center for Global Development, 13
October 2008. http//blogs.cgdev.org/globaldevelop
ment/2008/10/history_says_financial_crisis.php
21
What happens to aid following financial crises
David Roodman, Center for Global Development, 13
October 2008. http//blogs.cgdev.org/globaldevelop
ment/2008/10/history_says_financial_crisis.php
22
Total Health ODA 2001-2006
OECD-DAC Database Health ODA aggregates three
Creditor Reporting System sectors (1) Health
(2) Population Policies/Programmes Reproductive
Health (3) Water Supply/Sanitation Kaiser Family
Foundation www.kff.org/hivaids/upload/7679_02.pd
f
23
Health ODA Commitments by Major Sub-Sector, 2006
2.8 of total health ODA 4.4 of (1) and (2)
OECD-DAC Database Health ODA aggregates three
Creditor Reporting System sectors (1) Health
(2) Population Policies/Programmes Reproductive
Health (3) Water Supply/Sanitation Kaiser Family
Foundation www.kff.org/hivaids/upload/7679_02.pd
f
24
2. Health
World health expenditures US 4.4 trillion in
2005
www.who.int/nha/pie_chart_202005.pdf
25
Health expenditures 2003
26
Land area
www.worldmapper.org
Public health spending Territory size shows the
proportion of worldwide spending on public health
services that is spent there. This spending is
measured in purchasing power parity.
27
2. Health
Targets 2001 Abuja Declaration on HIV/AIDS, TB
and other related infectious diseases 15 of
domestic public spending to go on health
28
(No Transcript)
29
3. Research
Targets 2002 European Union Spend total of 3 of
GDP on RD by 2010 2003 African
Union/NEPAD Increase public spending on RD to at
least 1 of GDP within five years 1990
Commission on Health Research for Development 2
of national health budgets of LMICs and 5 of aid
for the health sector from development aid
agencies should be earmarked for research and
research capacity strengthening
30
Health RD and national RD as a of GDP (2005)
EU 3 target
AU 1 target
31
Strength of investments in health RD (2005)
2 target for LMICs
32
Global health RD expenditures
Global Forum for Health Research, Monitoring
Financial Flows for Health Research, 2008
33
Globalization of disease burdens
Deaths by cause and WHO region, 2002
34
'Neglected Diseases'

• Diseases
• that are significant sources of mortality and
  morbidity
• for which there are few or no adequate
  interventions (that are relevant to large,
  affected populations)
• that attract relatively little RD funding

35
'Neglected Diseases'
Mortality Estimates for 2002 (World Health Report
2004) Infectious and Parasitic diseases 10 904
(000) HIV/AIDS 2 777 Diarrhoeal
diseases 1 798 Tuberculosis 1
566 Malaria 1 272 Childhood
diseases 1 124 STIs (excluding HIV)
180 Meningitis 173
(Other) Tropical Diseases 129
Hepatitis B 103 Hepatitis C
54 Dengue
19 Japanese encephalitis
14 Intestinal nematodes 12
Leprosy 6

African trypanosomiaisis Chagas
Disease Leishmaniasis Leprosy Lymphatic
filariasis Onchocerciasis Schistosomiasis
36
Total Gates Foundation Grants by Disease (to 2005)
37
Fragmentation in international effort .
38
Diseases that disproportionately affect LMICs

• Type III
• Overwhelmingly or exclusively incident in
  developing countries
• Type II
• Incident in rich and poor countries but with a
  substantial proportion of the cases in poor
  countries
• Type I
• Incident in both rich and poor countries, with
  large numbers of vulnerable populations in each

39
Chronic diseases the new epidemicCancer,
Diabetes, Heart Disease, Stroke,
Mental/Neurological Conditions

• Becoming the dominant source of ill health and
  death in LMICs
• Driven by poor diet, lack of physical
  activity, tobacco use
• 57 million deaths in 2003 33 million attributed
  to chronic diseases
• 17 million attributed to cardiovascular disease
• 1/3 of these occurred in mid-aged people
• 1/3 occurred in China and India
• Estimated number of diabetics
• India 32 million
• China 21 million
• USA 18 million
• Indonesia 8 million
• 2000 global total over 170 million
• Estimated 2030 total over 360 million

40
Obesity rate doubles in 10 years in China
60 million obese 200 million overweight 20
million have diabetes 160 million have high
blood pressure First comprehensive Chinese
national survey on diet, nutrition and disease
reported October 13, 2004 (270 000 adults
surveyed)
41
Death rate ranking of 10 main diseases in
China, 2004
42
Chronic diseases the new epidemicCancer,
Diabetes, Heart Disease, Stroke,
Mental/Neurological Conditions

• Research agenda for NCDs
• relevant to health of the poor in LMICs
• Needs to include a wide range of research domains
• Effectiveness of existing (generic) drugs
  with different genetic groups and in different
  settings
• New drugs that are cheaper/more appropriate
  for different populations and settings
• Treatment regimes and health care systems
• Rapid, cheap, easy-to-use, robust diagnostics

43
Global health RD expenditures
Global Forum for Health Research, Monitoring
Financial Flows for Health Research, 2008
44
(No Transcript)
45
(No Transcript)