Foreign aid 1.6% of India's total health spend: Study

International aid for health may be in billions of dollars, but it is a fraction of what most recipient country governments spend on healthcare for their people. For instance, the $775 million that India got as development assistance in health (DAH) in 2010, though not a small amount by any measure, was just 1.6% of what the both centre and state governments put together spent on public health.

India received the highest amount as DAH in absolute terms, the fact that it was a fraction of what the government spent is significant considering that government spending on health is itself a mere 32% of the total health expenditure in India, the remaining 68% coming out of people's own pockets. Hence, out of the total expenditure on health in India in 2010, foreign aid was a mere 1.6%. Moreover, in per capita terms, foreign aid for health to India was among the lowest in the world, a mere 63 cents per person annually.

In 2010, while the total global DAH was $28.2 billion, the government's health expenditure of the countries receiving the DAH was more than 18 times higher at $521 billion. Thus, international aid was just 5.4% of the total spending on health by governments of recipient countries.

This was revealed in a recent report titled "Financing Global Health 2012: The End of the Golden Age?" brought out by the Institute for Health Metrics and Evaluation, University of Washington. This is IHME's fourth annual report on global health expenditure between 1990 and 2010.

DAH includes both financial and in-kind contributions for activities aimed at improving health in low- and middle-income countries. This includes financial DAH from bilateral development agencies including the World Bank (IDA and IBRD), Asian Development Bank (ADB), African Development Bank, Inter-American Development Bank, Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM), the Global Alliance for Vaccines and Immunisation (GAVI), and the Bill and Melinda Gates Foundation (BMGF).

For most countries receiving DAH, it constituted less than 10% of total spending by governments. This was true across most of South America, North Africa, and Asia. Governments in East Asia- primarily China - disbursed the most on health, at $159.6 billion in 2010.

South Asia, which accounts for one-fifth of the world's population, shows the least government expenditure on health, a mere $22 billion. Barring Sri Lanka and India, in all other South Asian countries, foreign aid for health accounts for over 10% of public health expenditure. Pakistan and Bangladesh received about $1.5 per capita from global health funds or a total DAH of $261 million and $251 million respectively. In China, the DAH per capita is less than 20 cents.

However, in certain countries in Asia and Western and Southern Africa, global health funds given to governments of countries amounted to more than half of total government health expenditure. The report warned against the reliance of these health systems on DAH in light of the decreasing level of DAH for governments from 2008 to 2010.

Over time, global development funds for health have flowed increasingly to NGOs. In 1995, DAH was mainly distributed to governments; NGOs received approximately $30 million, 2.4% of the total global health funds earmarked to be given to either governments or NGOs. By 2010, DAH for NGOs made up 65.3% of that total, with DAH funding for NGOs over that year amounting to more than $7.8 billion, which is $3.7 billion higher than DAH to governments in the same year.