Development assistance holds promise for alleviating the death and suffering of impoverished children, women, and men from readily preventable and treatable conditions and to support global economic development, demographic sustainability, and political stability. Although the desirability of these goals is widely shared, there is little agreement on who should shoulder the financial responsibility or how best to use development assistance to achieve these goals.
How much financing should be provided and in what form, who is eligible, and what health areas and interventions should be prioritized? How should institutions balance the financing for current interventions and for future priorities? Should funding for research and development (R&D) be a health aid priority? And what exactly counts as health aid? Does a favorable loan to build a hospital in rural China count? How about in rural Mali? How much health aid flows through recognized channels, and how much falls outside well-documented channels? What criteria should be used to allocate scarce health aid resources? Which countries and populations have the strongest claims to assistance or favorable financing? This chapter provides frameworks for addressing these questions and understanding the crossroads for foreign aid to the health sector. This chapter does not provide a systematic review of current patterns of health aid allocation. The descriptive epidemiology of health aid—the patterns of sources, channels, flows, and targets of donor resources—is available from other sources, which we reference throughout this chapter. Instead, we address key questions that challenge our understanding of the present and planning for the future of international cooperation on health.
The first section addresses the measurement of health aid, including an overview of common definitions and measurements of how health aid flows, from whom, to whom, and to what intended ends. The section also summarizes recent efforts to reconsider the scope of health aid, including aid originating in non–Organisation for Economic Co-operation and Development (OECD) countries and support for R&D and other global public goods.
The second section addresses the normative landscape of health aid: What are the goals for the provision of health aid and the criteria guiding its allocation? We illustrate the role of the implicit and explicit goals of health aid, including the alleviation of death and suffering, human development, national relationships, global health equity, and international security. We also address how implicit and explicit goals guide the provision of health aid across regions and countries and across disease and intervention areas.
The third section provides two case studies that illustrate patterns of health aid sources and the breadth of health aid efforts. The fourth draws lessons learned from the experience with health aid and identifies guiding principles for organizing and implementing health aid resources. We end with a summary and recommendations for future health aid investments. Investing these resources wisely will play an important role in achieving a grand convergence in global health and a decent life for all (Jamison and others 2013).
© 2018 International Bank for Reconstruction and Development / The World Bank.