Rachel Nugent

Where Have All the Donors Gone? Scarce Donor Funding for Non-Communicable Diseases

Health conditions in developing countries are becoming more like those in developed countries, with non-communicable diseases (NCDs) predominating and infectious diseases declining. The increased awareness of changing health needs, however, has not translated into significant shifts in resources or policy-level attention from international donors or governments in affected countries. Driven by changes in lifestyle related to nutrition, physical activity, and smoking, the surging burden of NCDs in poor countries portends painful choices, particularly for countries with weak health systems that are struggling to manage persistent infectious diseases burdens and to protect the poor from excessive out-of-pocket expenses. Global development assistance for health (DAH) was estimated at

Universal health coverage and intersectoral action for health: key messages from Disease Control Priorities, 3rd edition

21.8 billion in 2007 (Ravishankar et al., 2009). A recent assessment shows that official development assistance for health reached

Equity impacts of price policies to promote healthy behaviours

26.4 billion in 2008, surpassing all prior years (Kates et al., 2010). No specific mention is made of DAH for NCDs in developing countries in either study. This paper aims to fill that gap. We conducted an analysis of donor spending on NCDs in developing countries from 2001 to 2008 that reveals that less than 3 percent (

Action to address the household economic burden of non-communicable diseases

503 million out of

Investing in non-communicable disease prevention and management to advance the Sustainable Development Goals

22 billion) of overall DAH was dedicated to NCDs in 20078. The amount of donor assistance for health rose to

Cardiovascular, respiratory, and related disorders: key messages from Disease Control Priorities, 3rd edition

686 million in 2008. In terms of the burden of disease, donors provided about

A Chronology of Global Assistance Funding for NCD

0.78/DALY attributable to NCDs in developing countries in 2007, compared to

Ranking 93 health interventions for low- and middle-income countries by cost-effectiveness

29.9/DALY attributable to HIV, TB, and malaria. If donors provided just half the support to avoid NCD DALYs that they provide to the three infectious diseases, it would amount to almost

Extended Cost-Effectiveness Analyses of Cardiovascular Risk Factor Reduction Policies:

4 billion in DAH for NCDs. The picture of donor involvement in NCDs is not entirely bleak. Donor funding to developing countries for NCDs grew by 618 percent between 2001 and 2008, with the largest increase coming from private, non-profit donors, and evidence of accelerating interest from bilateral donors. Multilateral organizations remain the largest category of funders. Nonetheless, additional donor funding is needed to support developing-countries efforts to incorporate NCDs into their existing health care programs through such mechanisms and hypertension and cancer screening and prevention programs, and proven policy solutions such as tobacco taxation and salt reduction.

Addressing NCDs: A unifying agenda for sustainable development

The World Bank is publishing nine volumes of Disease Control Priorities, 3rd edition (DCP3) between 2015 and 2018. Volume 9, Improving Health and Reducing Poverty, summarises the main messages from all the volumes and contains cross-cutting analyses. This Review draws on all nine volumes to convey conclusions. The analysis in DCP3 is built around 21 essential packages that were developed in the nine volumes. Each essential package addresses the concerns of a major professional community (eg, child health or surgery) and contains a mix of intersectoral policies and health-sector interventions. 71 intersectoral prevention policies were identified in total, 29 of which are priorities for early introduction. Interventions within the health sector were grouped onto five platforms (population based, community level, health centre, first-level hospital, and referral hospital). DCP3 defines a model concept of essential universal health coverage (EUHC) with 218 interventions that provides a starting point for country-specific analysis of priorities. Assuming steady-state implementation by 2030, EUHC in lower-middle-income countries would reduce premature deaths by an estimated 4·2 million per year. Estimated total costs prove substantial: about 9·1% of (current) gross national income (GNI) in low-income countries and 5·2% of GNI in lower-middle-income countries. Financing provision of continuing intervention against chronic conditions accounts for about half of estimated incremental costs. For lower-middle-income countries, the mortality reduction from implementing the EUHC can only reach about half the mortality reduction in non-communicable diseases called for by the Sustainable Development Goals. Full achievement will require increased investment or sustained intersectoral action, and actions by finance ministries to tax smoking and polluting emissions and to reduce or eliminate (often large) subsidies on fossil fuels appear of central importance. DCP3 is intended to be a model starting point for analyses at the country level, but country-specific cost structures, epidemiological needs, and national priorities will generally lead to definitions of EUHC that differ from country to country and from the model in this Review. DCP3 is particularly relevant as achievement of EUHC relies increasingly on greater domestic finance, with global developmental assistance in health focusing more on global public goods. In addition to assessing effects on mortality, DCP3 looked at outcomes of EUHC not encompassed by the disability-adjusted life-year metric and related cost-effectiveness analyses. The other objectives included financial protection (potentially better provided upstream by keeping people out of the hospital rather than downstream by paying their hospital bills for them), stillbirths averted, palliative care, contraception, and child physical and intellectual growth. The first 1000 days after conception are highly important for child development, but the next 7000 days are likewise important and often neglected.