Skip to main page content
Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
, 33 (suppl_1), i14-i23

Allocation of Development Assistance for Health: Is the Predominance of National Income Justified?

Affiliations

Allocation of Development Assistance for Health: Is the Predominance of National Income Justified?

Olivier Sterck et al. Health Policy Plan.

Abstract

Gross national income (GNI) per capita is widely regarded as a key determinant of health outcomes. Major donors heavily rely on GNI per capita to allocate development assistance for health (DAH). This article questions this paradigm by analysing the determinants of health outcomes using cross-sectional data from 99 countries in 2012. We use disability-adjusted life years (Group I) per capita as our main indicator for health outcomes. We consider four primary variables: GNI per capita, institutional capacity, individual poverty and the epidemiological surroundings. Our empirical strategy has two innovations. First, we construct a health poverty line of 10.89 international-$ per day, which measures the minimum level of income an individual needs to have access to basic healthcare. Second, we take the contagious nature of communicable diseases into account, by estimating the extent to which the population health in neighbouring countries (the epidemiological surroundings) affects health outcomes. We apply a spatial two-stage least-squares model to mitigate the risks of reverse causality. Our model captures 92% of the variation in health outcomes. We emphasize four findings. First, GNI per capita is not a significant predictor of health outcomes once other factors are controlled for. Second, the poverty gap below the 10.89 health poverty line is a good measure of universal access to healthcare, as it explains 19% of deviation in health outcomes. Third, the epidemiological surroundings in which countries are embedded capture as much as 47% of deviation in health outcomes. Finally, institutional capacity explains 10% of deviation in health outcomes. Our empirical findings suggest that allocation frameworks for DAH should not only take into account national income, which remains an important indicator of countries' financial capacity, but also individual poverty, governance and epidemiological surroundings to increase impact on health outcomes.

Keywords: Communicable diseases; development assistance for health; gross national income; poverty.

Figures

Figure 1.
Figure 1.
The health value chain within the epidemiological surroundings
Figure 2.
Figure 2.
Scatter plots between DALYs lost per 100 000 and GNI per capita for 140 countries, distinguishing between Group I DALYs and NCD DALYs
Figure 3.
Figure 3.
Decomposition of the contributions of our independent variables on Group I DALYs per country

Similar articles

  • New approaches to ranking countries for the allocation of development assistance for health: choices, indicators and implications.
    Ottersen T, Grépin KA, Henderson K, Pinkstaff CB, Norheim OF, Røttingen JA. Ottersen T, et al. Health Policy Plan. 2018 Feb 1;33(suppl_1):i31-i46. doi: 10.1093/heapol/czx027. Health Policy Plan. 2018. PMID: 29415238 Free PMC article.
  • Distributing development assistance for health: simulating the implications of 11 criteria.
    Ottersen T, Moon S, Røttingen JA. Ottersen T, et al. Health Econ Policy Law. 2017 Apr;12(2):245-263. doi: 10.1017/S1744133116000487. Health Econ Policy Law. 2017. PMID: 28332464
  • Growth, poverty alleviation and foreign assistance.
    Crosswell M. Crosswell M. Dev Dig. 1981 Jul;19(3):109-24. Dev Dig. 1981. PMID: 12263303
  • Tuberculosis.
    Bloom BR, Atun R, Cohen T, Dye C, Fraser H, Gomez GB, Knight G, Murray M, Nardell E, Rubin E, Salomon J, Vassall A, Volchenkov G, White R, Wilson D, Yadav P. Bloom BR, et al. In: Holmes KK, Bertozzi S, Bloom BR, Jha P, editors. Major Infectious Diseases. 3rd edition. Washington (DC): The International Bank for Reconstruction and Development / The World Bank; 2017 Nov 3. Chapter 11. Major Infectious Diseases. 3rd edition. 2017. PMID: 30212088 Free Books & Documents. Review.
  • Universal health coverage and intersectoral action for health: key messages from Disease Control Priorities, 3rd edition.
    Jamison DT, Alwan A, Mock CN, Nugent R, Watkins D, Adeyi O, Anand S, Atun R, Bertozzi S, Bhutta Z, Binagwaho A, Black R, Blecher M, Bloom BR, Brouwer E, Bundy DAP, Chisholm D, Cieza A, Cullen M, Danforth K, de Silva N, Debas HT, Donkor P, Dua T, Fleming KA, Gallivan M, Garcia PJ, Gawande A, Gaziano T, Gelband H, Glass R, Glassman A, Gray G, Habte D, Holmes KK, Horton S, Hutton G, Jha P, Knaul FM, Kobusingye O, Krakauer EL, Kruk ME, Lachmann P, Laxminarayan R, Levin C, Looi LM, Madhav N, Mahmoud A, Mbanya JC, Measham A, Medina-Mora ME, Medlin C, Mills A, Mills JA, Montoya J, Norheim O, Olson Z, Omokhodion F, Oppenheim B, Ord T, Patel V, Patton GC, Peabody J, Prabhakaran D, Qi J, Reynolds T, Ruacan S, Sankaranarayanan R, Sepúlveda J, Skolnik R, Smith KR, Temmerman M, Tollman S, Verguet S, Walker DG, Walker N, Wu Y, Zhao K. Jamison DT, et al. Lancet. 2018 Mar 17;391(10125):1108-1120. doi: 10.1016/S0140-6736(17)32906-9. Epub 2017 Nov 25. Lancet. 2018. PMID: 29179954 Free PMC article. Review.
See all similar articles

References

    1. Anand S, Bärnighausen T. 2004. Human resources and health outcomes: cross-country econometric study. Lancet 364: 1603–9. - PubMed
    1. Angrist JD, Pischke J. 2011. Mostly Harmless Econometrics: An Empiricist’s Companion. Princeton: Princeton University Press.
    1. Ataya N, Aluttis C, Flahault A, Atun R, Haines A. 2014. Improving the assessment and attribution of effects of development assistance for health. Lancet 384: 2256–9. - PubMed
    1. Atun R, Jaffar S, Nishtar S. et al. 2013. Improving responsiveness of health systems to non-communicable diseases. Lancet 381: 690–7. - PubMed
    1. Balabanova D, Mills A, Conteh L. et al. 2013. Good health at low cost 25 years on: lessons for the future of health systems strengthening. Lancet 381: 2118–33. - PubMed
Feedback