Who’s in Charge of Global Health Spending?

There’s something I’ve noticed when talking about international aid to people who work outside the development/aid community: they always assume that there’s someone, somewhere who’s in charge.

The concept they seem to have in mind is something like the Deist “Divine Watchmaker”—not a bearded fellow dictating our every move, but rather a benevolent force that set things in motion and is now generally keeping tabs on us.

The degree to which this is not in fact the case was driven home recently by a new study out of the Institute for Health Metrics and Evaluation at University of Washington which sought to follow every dollar—public and private—spent on development assistance in just one sector: health. One of the editors of the report, William Heisel, compared this colossal effort to counting the drops in a rain storm.

Lead researcher Nirmala Ravishankar and her team at UW uncovered several important stylized facts about global health spending over the last two decades (their results were published in the June 20 edition of the Lancet). For example, total health spending has almost quadrupled, from $5.6 billion in 1990 to $21.8 billion in 2007.

Now get ready for the bad news: Nearly one-third of the global health money spent by the very largest donor by far—the US government—is untraceable. The study highlights the large gaps in existing health data and comments, “Surprisingly, discussions about global health financing continue to take place in the absence of a comprehensive system for tracking [development assistance for health].”

The team plans to publish more results, delving deeper into transparency issues, towards the end of July.

Dr. Ravishankar put it better than we could: “If no one knows how exactly this money is being spent, then we will never know if it is making a difference.” Amen to that.