Global Aid Architecture for Health in Developing Countries Peter Berman Professor of the Practice of Global Health Systems and Economics September 22,

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Global Aid Architecture for Health in Developing Countries

Peter BermanProfessor of the Practice of Global Health Systems and EconomicsSeptember 22, 2014TopicsActorsThe Scale-up in FundingGovernanceCurrent initiativesDiscussion

Aid for HealthDAH = ODA + non-government external flowsUS $5.6 billion in 1990, growing to more than $31 billion by 20137 Development Banks30 Multilateral organizations90 Global Health Programs30 BilateralsThousands of NGOsPrivate philanthropy $5-6 billion/year by 2013

Plethora of Actors in Aid

MOHMOECMOFPMOPRIVATE SECTORCIVIL SOCIETYLOCALGVTNACPCTUCCAIDSINT NGOPEPFARNoradCIDARNEGTZSidaWBUNICEFUNAIDSWHOCFGFATMUSAID NCTP HSSPGFCCPDACCCMT-MAP3/5SWAPUNTG PRSPIsnt Donor Collaboration Wonderful?Source: WHO: MbeweAccounting for DAHTracking money is a useful way to describe scale, resource allocation, rolesFamiliar accounting issues:What is health?What are the best mutually exclusive allocation categories? Unpacking the flow of financing and avoiding double countingLinking to national financing

Who tracks DAH?OECD Development Assistance Committee (for ODA)Technical agencies: UNFPA, UNAIDSAcademic researchers: IHME, LSHTM, NIDICivil Society: One, Save the Children, othersCollaborations: Countdown to 2015National authorities: National Health AccountsNational Health Strategy and MTEF

Source: IHME 2014External Flows: By Source

Source: IHME 2014Source: Ravishankar et al, 2009

External Flows: By ChannelSource: IHME 2014

Source: IHME 2014

Trends in ODA+ for MNH, CH, and R*(Countdown to 2015 estimates)#Ten Countdown countries received just under half of total ODA+ for maternal, newborn and child health in 2011Source: Organisation for Economic Co-operation and Developments Development Assistance Committees Creditor Reporting System Aid Activities Database#16Seven Countdown countries received just over half of ODA+ to R* in 2011 (includes ODA for HIV/AIDS related programs)

Source: Organisation for Economic Co-operation and Developments Development Assistance Committees Creditor Reporting System Aid Activities Database#17INTERNATIONAL AID ARCHITECTURE18Private CapitalDebt Buy-backIFFIm Airline TaxGAVIMultilateral Banks

UN Agencies ( WHO & others)Bilateral Donors

UNITAID Global FundOfficial Development Assistance International PhilanthropyAMCBuy-downs, co-financingGlobal Health PartnershipsProduct Development PartnershipsDOMESTIC HEALTH SYSTEM ARCHITECTURE19Public ProvidersPrivate ProvidersPublic Health & Community Health Services

Individual Preventive Public Health InterventionsData, Health Education, Environmental Health Ministry FinanceMinistry ofHealthSocial SecurityHealth Service DeliveryHealth FinancingPopulationIndividual Health Interventions, Acute & Chronic CareHealth Strategy Out-of-Pocket Payments

Private PaymentsInsuranceOut of Pocket Money FlowGovernment Money FlowService Provision Public Providers20Private CapitalMultilateral Banks

UN Agencies ( WHO & others)Bilateral Agencies

Official Development Assistance Public ProvidersPrivate ProvidersPublic Health & Community Health

Individual Preventive Public Health InterventionsData, Health Education, Environmental Health Ministry FinanceMinistry ofHealthSocial SecurityHealth Service DeliveryHealth FinancingPopulationIndividual Health Interventions, Acute & Chronic CareHealth Strategy Out-of-Pocket Payments

Private PaymentsInsurancePublic ProvidersDebt Buy-backIFFIm Airline TaxGAVIUNITAID Global FundInternational PhilanthropyAMCBuy-downs, co-financingGlobal Health Partnerships20Donor contributions to medicines in Kenya

GovernanceDifferent global agencies have different governance structuresWHO World Health Assembly, member countries, one vote one countryWorld Bank Executive Board Directors representing members with votes weighted by ownership of Banks capitalGlobal Fund and GAVI Board with members including governments, agencies, CSOs, private sectorNational Aid agencies politicians, citizensPrivate Philanthropy and Corporations ownersQuestionsWhere did the decisions about current global health priorities (such as the MDGs) come from? Who should make decisions about global health priorities? DiseasesBeneficiariesHealth systemsHow should accountability for resource use and aid effectiveness be done? Current InitiativesGovernanceH4+1, H8Diseases, health problemsRoll back MalariaStop TBPartnership for Maternal, Newborn, and Child Healthand more e.g. Health system strengtheningHealth Metrics NetworkGlobal Health Workforce AllianceAlliance for Health Policy and Systems ResearchMedicines Transparency Allianceand moreMore than 170 different organizations and partnerships

24Recent Initiatives to Support Health SystemsWHO Maximizing Positive Synergies Collaborative GroupHigh Level Task Force on Innovative International Financing for Health Systems

Establish a health systems funding platform for the Global Fund, GAVI Alliance, the World Bank and others to coordinate, mobilize, streamline and channel the flow of existing and new international resources to support national health strategiesImprove alignment of planning processes and resource allocations among Global Health Initiatives, and between Global Health Initiatives and country health systemsInternational Health Partnership+ achieve better health results by mobilizing donor countries and other development partners around a single country-led national health strategy, guided by the principles of the Paris Declaration and the Accra Agenda for Action

25HNP Strategy - Strategic Directions: How should the Bank support country efforts to achieve results? 1. Renew Bank focus on HNP results. 2. Increase the Bank contribution to client-country efforts to strengthen and realize well-organized and sustainable health systems for HNP results. 3. Ensure synergy between health system strengthening and priority-disease interventions, particularly in LICs. 4. Strengthen Bank capacity to advise client countries on an intersectoral approach to HNP results. 5. Increase selectivity, improve strategic engagement, and reach agreement with global partners on collaborative division of labor for the benefit of client countries.

Strong and effective health systems are increasingly considered a prerequisite to reducing the disease burden and to achieving the health MDGs, rather than the outcome of increased investments in disease control. As a consequence, health systems strengthening (HSS) has risen to the top of the health development agenda. Acknowledging the increased importance of HSS in achieving better health outcomes, global health partners have been enhancing their commitments to HSS. Significantly increased financial, political and technical support to HSS has created a strong impetus for global health partners to collaborate and better coordinate their HSS strategies. In early 2009 the Chief Executives of the GFATM and GAVI informed the High level task force on innovative financing of their intention to begin jointly programming GAVI Alliance and GFATM resources towards health systems strengthening. In March 2009, the GFATM, GAVI and World Bank, with technical support from WHO, launched inter-agency consultations on aligning HSS funding frameworks with the aim of developing mechanisms for joint HSS funding and programming.

Possible Components of a Joint Approach to HSS Support for national health strategy development

Joint HSS processes including Joint Assessment of National Strategies (JANS) for funding HSS components

Common monitoring framework using annual review processes for monitoring performance

Common funding/disbursement channels26In practice, joint programming could be a combination of these options:

Linking review of proposal and joint appraisal Joint assessment + TRP/IRCJoint assessment without TRP/IRCHarmonized and aligned budgeting and planning Pooled fundingUse of common monitoring frameworks

RMNCH 2010-2013 and onAdvocacy: neglected MDGs, Countdown 2015, Women Deliver conferences, PMNCH partners meetingsMobilizing international momentum: G8 chaired by Canada in 2010 the Muskoka initiative; UN Secy Genls Global Action PlanUN General Assembly MDG Summit 2010Commitment -- $40+ BillionCommitments from both developed and developing countries: new donors, domestic commitmentsCommission on Information and Accountability (2010-2011) (www.everywomaneverychild.org)New International Advisory Group for UNSGNewer initiatives: ENAP, APR, FP2020Global and national accountability effortsThis week update at UN General AssemblyNon-communicable diseases2012 events? Emerging global disease epidemics -- CVD, Diabetes, Cancer -- and risk factors smoking, diet, exerciseNew technologies, new delivery challengesMany new stakeholdersWhat happens after 2015? How much progress?Sustaining current commitmentsNew commitments in the current global economy?

Post 2015 Sustainable Development GoalsLonger, more open, consultative processOpen Working Group reporting this week: Current proposal: 17 goals and 169 targets (MDGs, 8 goals and 21 targets)Goal 3. Ensure healthy lives and promote well-being for all at all ages13 Targets including some from MDGs and othersWhat was effect of MDGs? What will be effect of SDGs? Viewing the Global Health Architecture from the Country and CommunityNational resources still eclipse external in most countries sometimes by a huge margin. But the number of countries where aid is a third or more of health spending has risen dramatically. Larger and/or better governed countries may be better able to manage external health architectureMany countries have limited technical capacity at country level to coordinate multiple finance flows (Uganda received aid from over 40 different donors between 2003-07, involving 648 different aid instruments and agreements, many separate missions, reports, studies, etc.)Countries also face internal governance issues how well do governments represent communities?

Commitments are episodic and time bound. Try managing this

Aid Volatility

31

5 Principles of the Paris Declaration on Donor Harmonization

Ownership: partner countries exercise authority over their development policies, strategies & national health systems when relying on aidAlignment: donors base their overall support on partner countries national health and development strategies and proceduresHarmonisation: donors organise their multiple activities in ways that maximize their collective efficacyManaging for results: countries manage resources and improve decision making for resultsMutual accountability: donor and developing countries will be mutually accountable for development resultsAid SkepticsThere are significant voices who doubt the value of aid e.g. William Easterly, Dambisa Moyo, Lant PritchettArguments?DependencyCrowds out private and domestic action -- distortionLimited and controversial evidence of effectivenessTechnical aspectsWeak capacities and self-interested behavior of donors and recipientsCorruptionIn health, public goods and market failure arguments are still persuasive, but the scope of market failures in health may be narrower than many would like to acceptConcluding ThoughtsWe face the problems of success unprecedented global attention to health so far sustaining despite global economic crisisNumerous new organizational solutions perceived by many as moderately successfulHave the solutions also become a new problem? Can we improve enough to sustain or accelerate progress?Has the wave for health peaked? And what is your view about that? Chart14.01463696349.94768526086.456096726786.570571711429.396768244710.001276261558.857526771115.763799912228.435338641638.33119628536.901909475420.99416680052.64785652538.757039470324.036095538471.27727175882.280477705513.726159561558.89584481432.2540330268

MauritaniaTanzaniaMaliEritreaDonor Commitments as a percentage of Total Health Expenditure

TotalHealthas%ofGDPHealth expenditure, total (% of GDP)19971998199920002001Angola3.93.53.33.54.4Benin3.73.83.94.24.4Burundi3.13.23.23.53.6Cameroon3.73.43.13.13.3Central African Republic3.644.14.34.5Chad2.82.32.73.12.6Comoros3.133.13.13.1Congo, Dem. Rep.3.333.13.23.5Congo, Rep.33.12.622.1Cote d'Ivoire6.26.46.36.26.2Equatorial Guinea34.12.82.12Eritrea4.455.45.65.7Ethiopia3.43.63.53.23.6Gambia, The6.17.16.76.36.4Ghana4.14.34.24.34.7Guinea3.63.33.63.43.5Guinea-Bissau5.45.55.96.15.9Kenya88.47.98.77.8Lesotho5.35.96.16.15.5Liberia3.23.544.24.3Madagascar1.82.72.52.42Malawi8.78.58.78.27.8Mali4.24.24.14.74.3Mauritania3.43.63.63.73.6Mozambique54.955.75.9Niger3.43.33.23.63.7Nigeria2.83.1333.4Rwanda555.55.65.5Sao Tome and Principe32.92.32.42.3Senegal5.14.94.74.64.8Sierra Leone3.333.74.34.3Somalia2.62.72.72.62.6Sudan3.53.73.73.93.5Tanzania4.14.44.34.44.4Togo33.5432.8Uganda3.944.15.65.9Zambia665.75.55.7Zimbabwe9.311.47.97.46.2

SummaryForSelectedCountries19971998199920002001Guinea1.93087433029.45446436540.879029143312.07751314125.1259431068Benin8.874258160222.26521392156.178172585615.97052214534.4374717322Burundi3.132257568715.19031803540.83603448582.71390669552.2676810753Liberia8.308710456918.726403132910.780937795113.89058823667.10598017919971998199920002001Mauritania4.014636963429.396768244728.43533864162.64785652532.2804777055Tanzania9.947685260810.001276261538.33119628538.757039470313.7261595615Mali6.456096726758.85752677116.901909475424.036095538458.8958448143Eritrea86.570571711415.763799912220.994166800571.27727175882.2540330268

SummaryForSelectedCountries00000000000000000000

GuineaBeninBurundiLiberiaFigure 4. Percentage of Total Health Expenditure Financed by External Sources

Donorfundingas%ofTotalHealth00000000000000000000

MauritaniaTanzaniaMaliEritreaFigure 3. Percentage of Total Health Expenditure Financed by External Sources

TotalHealthincurrentUS$19971998199920002001averageRwanda0.65720886580.95422162770.53412545660.70530070010.34090504330.6383523387Congo, Rep.1.18427789331.12429354740.74545813751.6411843970.84514051521.1080708981Equatorial Guinea1.03351248361.45698982180.44800721341.49724045411.27097345131.1413446849Togo0.3086800541.21128882450.19685734463.60967989460.83624178321.2325495802Gambia, The2.54111720414.00558918620.27146000460.1974728840.14559009911.4322458756Central African Republic0.68138489995.29323459463.74859127760.38692029721.71867837952.3657618898Guinea-Bissau7.00880263422.08443295830.10601116820.65049723862.83018752282.5359863044Burundi3.132257568715.19031803540.83603448582.71390669552.26768107534.8280395721Guinea1.93087433029.45446436540.879029143312.07751314125.12594310685.8935648174Sierra Leone10.24783438452.40392055712.110127597614.93982778161.50827869856.2419978039Niger3.53275401074.59470537892.37352086783.422425465118.77788029896.5402572043Comoros8.17594413218.37106159793.00049834832.21739100172.01875167846.7567293517Angola5.36226292062.47455027445.271507150110.58547866610.75948501426.8906568051Zimbabwe4.80520651854.0071693972.435094899310.966072011414.64022443797.3707534528Sao Tome and Principe0.40926766040.254880853921.94915979257.21685349837.67366918537.5007661981Malawi3.70225680525.460323304419.39583901499.26513508484.04322224648.3733552911Zambia0.81720953233.906575047612.18463824969.120228630724.692756195110.1442815311Cote d'Ivoire7.458311170119.6961961425.76659336721.41733013153.097235915711.4871333449Benin8.874258160222.26521392156.178172585615.97052214534.437471732211.545127709Liberia8.308710456918.726403132910.780937795113.89058823667.10598017911.7625239601Mauritania4.014636963429.396768244728.43533864162.64785652532.280477705513.3550156161Tanzania9.947685260810.001276261538.33119628538.757039470313.726159561516.1526713679Somalia7.975237631314.163018946117.367543842222.593553786225.76187312417.5722454659Mali6.456096726758.85752677116.901909475424.036095538458.895844814331.0294946652Eritrea86.570571711415.763799912220.994166800571.27727175882.254033026839.3719686419Cameroon20.172973876326.945545433538.4307886027123.53021715523.239592360246.4638234856Nigeria4.75060375263.596074417158.430697321110.9090858541122.486883922360.0346690534Chad35.271532514127.5556764208177.1449457638176.879237755814.978325928486.3659436766Uganda58.994442078109.434159429557.2615682458160.822923492857.35672936788.7739645226Mozambique76.436197774141.129565265289.0399523954186.126603398122.401340522103.0267318709Ghana288.2948978401173.318285760293.3552279086170.488726270586.7859775667162.4486230692Ethiopia76.0083905082609.106857233267.871512591288.335811401578.668886785183.9982917038Congo, Dem. Rep.167.6300487192234.5758152048182.1815766203337.0258525785388.0892938497261.9005173945Kenya53.588943919242.7406202894.2060228701557.6180165359525.9028606741294.8112928558Madagascar154.7523562765641.604663618614.852331371754.8091720529112.2238959581315.6484838554Senegal4138.43721044821408.59968325961239.1023862501492.11182529381680.66386136861791.782993324Lesotho0.418769590100.03962123841.27101469760.5909786848Sudan

OECD_DonorfundingforHealth19971998199920002001Angola299340600225582000200963400310033500416741600Benin79801600887148009310860094701600104359200Burundi80674400894240008996160091024500101300400Cameroon3542269029846900221414402103474022744590Central African Republic328150800348124000376671100381809900386586000Chad2809240024085600283851002953804025154480Comoros4673870052242000475571004309930051760700Congo, Dem. Rep.69993006467700690959065401607682500Congo, Rep.18320700019235190012249380086086000102480000Cote d'Ivoire144007400124768000148295700199633800172831200Equatorial Guinea351660000524062000351568000222138000214700000Eritrea2190056022790000470890807509600097042500Ethiopia2334066026808480254702002049984025476120Gambia, The389228800462607600435345900411251400416608000Ghana1679524017912080181414801809827019642240Guinea247824000246642000277552800169238400185822000Guinea-Bissau204325200197340000204204900189868600179466200Kenya2148320017267040177244401874589015631980Lesotho569485000662511000644099000636840000617870000Liberia3277440031153500364344003609228033009380Madagascar53262009709200110450001299600010688000Malawi308475900317781000323413800317963200353308800Mali10641120072933000742141008021490072584000Mauritania8415680093484800925344008963250094669200Mozambique5481000049112700478945005355891057935640Niger115491200127835400127507200132649200127128300Nigeria5167680064377700605460005395200066140200Rwanda18114500001607200000200810500023563680002347070000Sao Tome and Principe5554800057689700444176004346160039162100Senegal22405322000376220580421382642252880Sierra Leone144358500139572000175787000188051900198255800Somalia2208674018148320180716401653808019476340SudanTanzania434887000509300000462164000536404000599192000Togo230517000293387500345504000272379000261536800Uganda5845710056652000582651006836480074263300Zambia376152000392058000340056300324016000321531300Zimbabwe363667200369040800247372700239589800225487800

GDP(currentUS$)Amount in millions of USD19971998199920002001Angola16.051435.5821410.593832.8185344.83925Benin7.081819.752545.7524115.124344.63091Burundi2.5269313.583790.752112.470322.29717Cameroon7.145818.042418.5091325.984265.28575Central African Rep.2.2359718.4270214.119861.47736.64417Chad9.908626.6369550.2827752.246663.76772Comoros3.821339.597411.426950.955681.04492Congo Dem.Rep. (Zaire)11.7329315.1716612.58822.0420329.81496Congo - Rep.2.169682.16260.913141.412830.8661Cote d'Ivoire10.7405224.5745538.210752.829475.35299Equatorial Guinea3.634457.635531.575053.325942.72878Eritrea18.959443.592579.8859653.526382.18737Ethiopia17.74086163.2922917.2870118.108720.04178Gambia9.8907618.530161.181790.812110.60654Ghana48.4198231.0449116.9360230.8555117.04671Guinea4.7851723.318682.4397720.439799.52513Guinea-Bissau14.320754.113420.216481.235095.07923Kenya11.5126241.9141216.69749104.5304682.20903Lesotho2.38483-0.25528.094333.65148Liberia2.723135.833933.927975.013432.34564Madagascar8.2424262.2946867.910447.12311.99449Malawi11.4205717.3518762.7288229.4597214.28506Mali6.8700142.926565.1221919.2805342.74896Mauritania3.3785927.4815126.312472.373342.15891Mozambique41.8946820.1998442.6452499.6873870.914Niger4.080025.873663.026414.5398223.872Nigeria2.454962.3150735.3774559.8376781.01307Rwanda11.9050115.3362510.725816.619488.00128Sao Tome & Principe0.227340.147049.749293.136563.00517Senegal92.7230128.1772927.3321710.5226537.86334Sierra Leone14.793623.35523.7093328.094632.99025Somalia1.761472.570353.13863.736545.01747Sudan4.9918.5811515.3853710.3728710.26898Tanzania43.2611950.9365177.1529946.9731182.24605Togo0.711563.553770.680159.832012.18708Uganda34.4864461.9966433.36351109.9462742.595Zambia3.0739515.3160441.4346329.55179.39494Zimbabwe17.4749614.788096.0237626.2735933.01192

Sheet2GDP (current US$)19971998199920002001Angola7.68E+096.45E+096.09E+098.86E+099.47E+09Benin2.16E+092.33E+092.39E+092.25E+092.37E+09Burkina Faso2.60E+092.79E+092.81E+092.60E+092.81E+09Burundi9.57E+088.78E+087.14E+086.79E+086.89E+08Cameroon9.12E+098.70E+099.19E+098.88E+098.59E+09Central African Republic1.00E+091.05E+091.05E+099.53E+089.67E+08Chad1.51E+091.74E+091.53E+091.39E+091.67E+09Comoros2.12E+082.16E+082.23E+082.04E+082.20E+08Congo, Dem. Rep.6.11E+096.20E+094.71E+094.30E+094.88E+09Congo, Rep.2.32E+091.95E+092.35E+093.22E+092.79E+09Cote d'Ivoire1.17E+101.28E+101.26E+101.06E+101.07E+10Equatorial Guinea4.98E+084.56E+088.72E+081.34E+091.70E+09Eritrea6.86E+087.45E+087.28E+086.41E+087.08E+08Ethiopia6.38E+096.52E+096.50E+096.53E+096.51E+09Gambia, The4.10E+084.17E+084.32E+084.21E+084.18E+08Ghana6.88E+097.47E+097.71E+094.98E+095.31E+09Guinea3.78E+093.59E+093.46E+093.11E+093.04E+09Guinea-Bissau2.69E+082.06E+082.24E+082.15E+082.00E+08Kenya1.07E+101.12E+101.06E+101.04E+101.12E+10Lesotho1.02E+098.90E+089.11E+088.59E+087.68E+08Liberia2.96E+083.60E+084.42E+085.42E+085.34E+08Madagascar3.55E+093.74E+093.72E+093.88E+094.53E+09Malawi2.53E+091.74E+091.81E+091.71E+091.69E+09Mali2.48E+092.60E+092.57E+092.42E+092.63E+09Mauritania1.10E+091.00E+099.58E+089.40E+089.82E+08Mozambique3.40E+093.87E+093.98E+093.68E+093.44E+09Niger1.85E+092.08E+092.02E+091.80E+091.95E+09Nigeria3.62E+103.21E+103.65E+104.21E+104.27E+10Rwanda1.85E+091.99E+091.93E+091.81E+091.70E+09Sao Tome and Principe4.39E+074.08E+074.69E+074.65E+074.69E+07Senegal4.37E+094.65E+094.75E+094.37E+094.61E+09Sierra Leone8.49E+086.72E+086.69E+086.36E+087.49E+08Somalia..........Sudan1.06E+101.16E+101.07E+101.22E+101.36E+10Tanzania7.68E+098.38E+098.64E+099.08E+099.34E+09Togo1.50E+091.42E+091.42E+091.22E+091.26E+09Uganda6.27E+096.53E+095.97E+095.89E+095.64E+09Zambia3.91E+093.24E+093.13E+093.24E+093.64E+09Zimbabwe8.43E+095.73E+095.49E+097.20E+099.06E+09

Sheet5Health expenditure, public (% of total health expenditure)19971998199920002001Angola45.239.844.355.863.1Benin3436.538.643.346.9Burundi50.353.855.355.659Cameroon21.219.222.833.737.1Central African Republic37.944.44849.251.2Chad78.172.77578.776Comoros60.358.659.659.760Congo, Dem. Rep.47.141.741.544.744.4Congo, Rep.70.376.970.673.363.8Cote d'Ivoire1919.22015.416Equatorial Guinea63.16261.962.560.4Eritrea65.866.167.667.265.1Ethiopia37.939.337.734.540.5Gambia, The47.242.946.946.849.4Ghana47.653.853.955.959.6Guinea56.351.455.353.454.1Guinea-Bissau43.244.548.555.353.8Kenya21.724.118.723.821.4Lesotho7678.380.980.878.9Liberia69.173.476.576.275.9Madagascar78.464.458.564.865.9Malawi35.635.537.836.935Mali43.337.532.638.938.6Mauritania74.571.171.973.572.4Mozambique60.5626466.667.4Niger41.74343.643.139.1Nigeria11.715.41614.123.2Rwanda48.851.35452.955.5Sao Tome and Principe66.767.967.967.867.7Senegal54.857.556.156.658.8Sierra Leone46.844.253.860.461Somalia45.546.14544.844.6Sudan19.624.422.928.718.7Tanzania45.947.143.447.146.7Togo50.259.662.848.748.6Uganda29.13840.956.157.5Zambia55.156.954.852.553.1Zimbabwe59.155.948.950.745.3

Sheet6

Chart21.93087433028.87425816023.13225756878.30871045699.454464365422.265213921515.190318035418.72640313290.87902914336.17817258560.836034485810.780937795112.077513141215.97052214532.713906695513.89058823665.12594310684.43747173222.26768107537.105980179

GuineaBeninBurundiLiberiaPercentage of Total Health Expenditure Financed by External Sources

TotalHealthas%ofGDPHealth expenditure, total (% of GDP)19971998199920002001Angola3.93.53.33.54.4Benin3.73.83.94.24.4Burundi3.13.23.23.53.6Cameroon3.73.43.13.13.3Central African Republic3.644.14.34.5Chad2.82.32.73.12.6Comoros3.133.13.13.1Congo, Dem. Rep.3.333.13.23.5Congo, Rep.33.12.622.1Cote d'Ivoire6.26.46.36.26.2Equatorial Guinea34.12.82.12Eritrea4.455.45.65.7Ethiopia3.43.63.53.23.6Gambia, The6.17.16.76.36.4Ghana4.14.34.24.34.7Guinea3.63.33.63.43.5Guinea-Bissau5.45.55.96.15.9Kenya88.47.98.77.8Lesotho5.35.96.16.15.5Liberia3.23.544.24.3Madagascar1.82.72.52.42Malawi8.78.58.78.27.8Mali4.24.24.14.74.3Mauritania3.43.63.63.73.6Mozambique54.955.75.9Niger3.43.33.23.63.7Nigeria2.83.1333.4Rwanda555.55.65.5Sao Tome and Principe32.92.32.42.3Senegal5.14.94.74.64.8Sierra Leone3.333.74.34.3Somalia2.62.72.72.62.6Sudan3.53.73.73.93.5Tanzania4.14.44.34.44.4Togo33.5432.8Uganda3.944.15.65.9Zambia665.75.55.7Zimbabwe9.311.47.97.46.2

SummaryForSelectedCountries19971998199920002001Guinea1.93087433029.45446436540.879029143312.07751314125.1259431068Benin8.874258160222.26521392156.178172585615.97052214534.4374717322Burundi3.132257568715.19031803540.83603448582.71390669552.2676810753Liberia8.308710456918.726403132910.780937795113.89058823667.10598017919971998199920002001Mauritania4.014636963429.396768244728.43533864162.64785652532.2804777055Tanzania9.947685260810.001276261538.33119628538.757039470313.7261595615Mali6.456096726758.85752677116.901909475424.036095538458.8958448143Eritrea86.570571711415.763799912220.994166800571.27727175882.2540330268

SummaryForSelectedCountries00000000000000000000

GuineaBeninBurundiLiberiaFigure 4. Percentage of Total Health Expenditure Financed by External Sources

Donorfundingas%ofTotalHealth00000000000000000000

MauritaniaTanzaniaMaliEritreaFigure 3. Percentage of Total Health Expenditure Financed by External Sources

TotalHealthincurrentUS$19971998199920002001averageRwanda0.65720886580.95422162770.53412545660.70530070010.34090504330.6383523387Congo, Rep.1.18427789331.12429354740.74545813751.6411843970.84514051521.1080708981Equatorial Guinea1.03351248361.45698982180.44800721341.49724045411.27097345131.1413446849Togo0.3086800541.21128882450.19685734463.60967989460.83624178321.2325495802Gambia, The2.54111720414.00558918620.27146000460.1974728840.14559009911.4322458756Central African Republic0.68138489995.29323459463.74859127760.38692029721.71867837952.3657618898Guinea-Bissau7.00880263422.08443295830.10601116820.65049723862.83018752282.5359863044Burundi3.132257568715.19031803540.83603448582.71390669552.26768107534.8280395721Guinea1.93087433029.45446436540.879029143312.07751314125.12594310685.8935648174Sierra Leone10.24783438452.40392055712.110127597614.93982778161.50827869856.2419978039Niger3.53275401074.59470537892.37352086783.422425465118.77788029896.5402572043Comoros8.17594413218.37106159793.00049834832.21739100172.01875167846.7567293517Angola5.36226292062.47455027445.271507150110.58547866610.75948501426.8906568051Zimbabwe4.80520651854.0071693972.435094899310.966072011414.64022443797.3707534528Sao Tome and Principe0.40926766040.254880853921.94915979257.21685349837.67366918537.5007661981Malawi3.70225680525.460323304419.39583901499.26513508484.04322224648.3733552911Zambia0.81720953233.906575047612.18463824969.120228630724.692756195110.1442815311Cote d'Ivoire7.458311170119.6961961425.76659336721.41733013153.097235915711.4871333449Benin8.874258160222.26521392156.178172585615.97052214534.437471732211.545127709Liberia8.308710456918.726403132910.780937795113.89058823667.10598017911.7625239601Mauritania4.014636963429.396768244728.43533864162.64785652532.280477705513.3550156161Tanzania9.947685260810.001276261538.33119628538.757039470313.726159561516.1526713679Somalia7.975237631314.163018946117.367543842222.593553786225.76187312417.5722454659Mali6.456096726758.85752677116.901909475424.036095538458.895844814331.0294946652Eritrea86.570571711415.763799912220.994166800571.27727175882.254033026839.3719686419Cameroon20.172973876326.945545433538.4307886027123.53021715523.239592360246.4638234856Nigeria4.75060375263.596074417158.430697321110.9090858541122.486883922360.0346690534Chad35.271532514127.5556764208177.1449457638176.879237755814.978325928486.3659436766Uganda58.994442078109.434159429557.2615682458160.822923492857.35672936788.7739645226Mozambique76.436197774141.129565265289.0399523954186.126603398122.401340522103.0267318709Ghana288.2948978401173.318285760293.3552279086170.488726270586.7859775667162.4486230692Ethiopia76.0083905082609.106857233267.871512591288.335811401578.668886785183.9982917038Congo, Dem. Rep.167.6300487192234.5758152048182.1815766203337.0258525785388.0892938497261.9005173945Kenya53.588943919242.7406202894.2060228701557.6180165359525.9028606741294.8112928558Madagascar154.7523562765641.604663618614.852331371754.8091720529112.2238959581315.6484838554Senegal4138.43721044821408.59968325961239.1023862501492.11182529381680.66386136861791.782993324Lesotho0.418769590100.03962123841.27101469760.5909786848Sudan

OECD_DonorfundingforHealth19971998199920002001Angola299340600225582000200963400310033500416741600Benin79801600887148009310860094701600104359200Burundi80674400894240008996160091024500101300400Cameroon3542269029846900221414402103474022744590Central African Republic328150800348124000376671100381809900386586000Chad2809240024085600283851002953804025154480Comoros4673870052242000475571004309930051760700Congo, Dem. Rep.69993006467700690959065401607682500Congo, Rep.18320700019235190012249380086086000102480000Cote d'Ivoire144007400124768000148295700199633800172831200Equatorial Guinea351660000524062000351568000222138000214700000Eritrea2190056022790000470890807509600097042500Ethiopia2334066026808480254702002049984025476120Gambia, The389228800462607600435345900411251400416608000Ghana1679524017912080181414801809827019642240Guinea247824000246642000277552800169238400185822000Guinea-Bissau204325200197340000204204900189868600179466200Kenya2148320017267040177244401874589015631980Lesotho569485000662511000644099000636840000617870000Liberia3277440031153500364344003609228033009380Madagascar53262009709200110450001299600010688000Malawi308475900317781000323413800317963200353308800Mali10641120072933000742141008021490072584000Mauritania8415680093484800925344008963250094669200Mozambique5481000049112700478945005355891057935640Niger115491200127835400127507200132649200127128300Nigeria5167680064377700605460005395200066140200Rwanda18114500001607200000200810500023563680002347070000Sao Tome and Principe5554800057689700444176004346160039162100Senegal22405322000376220580421382642252880Sierra Leone144358500139572000175787000188051900198255800Somalia2208674018148320180716401653808019476340SudanTanzania434887000509300000462164000536404000599192000Togo230517000293387500345504000272379000261536800Uganda5845710056652000582651006836480074263300Zambia376152000392058000340056300324016000321531300Zimbabwe363667200369040800247372700239589800225487800

GDP(currentUS$)Amount in millions of USD19971998199920002001Angola16.051435.5821410.593832.8185344.83925Benin7.081819.752545.7524115.124344.63091Burundi2.5269313.583790.752112.470322.29717Cameroon7.145818.042418.5091325.984265.28575Central African Rep.2.2359718.4270214.119861.47736.64417Chad9.908626.6369550.2827752.246663.76772Comoros3.821339.597411.426950.955681.04492Congo Dem.Rep. (Zaire)11.7329315.1716612.58822.0420329.81496Congo - Rep.2.169682.16260.913141.412830.8661Cote d'Ivoire10.7405224.5745538.210752.829475.35299Equatorial Guinea3.634457.635531.575053.325942.72878Eritrea18.959443.592579.8859653.526382.18737Ethiopia17.74086163.2922917.2870118.108720.04178Gambia9.8907618.530161.181790.812110.60654Ghana48.4198231.0449116.9360230.8555117.04671Guinea4.7851723.318682.4397720.439799.52513Guinea-Bissau14.320754.113420.216481.235095.07923Kenya11.5126241.9141216.69749104.5304682.20903Lesotho2.38483-0.25528.094333.65148Liberia2.723135.833933.927975.013432.34564Madagascar8.2424262.2946867.910447.12311.99449Malawi11.4205717.3518762.7288229.4597214.28506Mali6.8700142.926565.1221919.2805342.74896Mauritania3.3785927.4815126.312472.373342.15891Mozambique41.8946820.1998442.6452499.6873870.914Niger4.080025.873663.026414.5398223.872Nigeria2.454962.3150735.3774559.8376781.01307Rwanda11.9050115.3362510.725816.619488.00128Sao Tome & Principe0.227340.147049.749293.136563.00517Senegal92.7230128.1772927.3321710.5226537.86334Sierra Leone14.793623.35523.7093328.094632.99025Somalia1.761472.570353.13863.736545.01747Sudan4.9918.5811515.3853710.3728710.26898Tanzania43.2611950.9365177.1529946.9731182.24605Togo0.711563.553770.680159.832012.18708Uganda34.4864461.9966433.36351109.9462742.595Zambia3.0739515.3160441.4346329.55179.39494Zimbabwe17.4749614.788096.0237626.2735933.01192

Sheet2GDP (current US$)19971998199920002001Angola7.68E+096.45E+096.09E+098.86E+099.47E+09Benin2.16E+092.33E+092.39E+092.25E+092.37E+09Burkina Faso2.60E+092.79E+092.81E+092.60E+092.81E+09Burundi9.57E+088.78E+087.14E+086.79E+086.89E+08Cameroon9.12E+098.70E+099.19E+098.88E+098.59E+09Central African Republic1.00E+091.05E+091.05E+099.53E+089.67E+08Chad1.51E+091.74E+091.53E+091.39E+091.67E+09Comoros2.12E+082.16E+082.23E+082.04E+082.20E+08Congo, Dem. Rep.6.11E+096.20E+094.71E+094.30E+094.88E+09Congo, Rep.2.32E+091.95E+092.35E+093.22E+092.79E+09Cote d'Ivoire1.17E+101.28E+101.26E+101.06E+101.07E+10Equatorial Guinea4.98E+084.56E+088.72E+081.34E+091.70E+09Eritrea6.86E+087.45E+087.28E+086.41E+087.08E+08Ethiopia6.38E+096.52E+096.50E+096.53E+096.51E+09Gambia, The4.10E+084.17E+084.32E+084.21E+084.18E+08Ghana6.88E+097.47E+097.71E+094.98E+095.31E+09Guinea3.78E+093.59E+093.46E+093.11E+093.04E+09Guinea-Bissau2.69E+082.06E+082.24E+082.15E+082.00E+08Kenya1.07E+101.12E+101.06E+101.04E+101.12E+10Lesotho1.02E+098.90E+089.11E+088.59E+087.68E+08Liberia2.96E+083.60E+084.42E+085.42E+085.34E+08Madagascar3.55E+093.74E+093.72E+093.88E+094.53E+09Malawi2.53E+091.74E+091.81E+091.71E+091.69E+09Mali2.48E+092.60E+092.57E+092.42E+092.63E+09Mauritania1.10E+091.00E+099.58E+089.40E+089.82E+08Mozambique3.40E+093.87E+093.98E+093.68E+093.44E+09Niger1.85E+092.08E+092.02E+091.80E+091.95E+09Nigeria3.62E+103.21E+103.65E+104.21E+104.27E+10Rwanda1.85E+091.99E+091.93E+091.81E+091.70E+09Sao Tome and Principe4.39E+074.08E+074.69E+074.65E+074.69E+07Senegal4.37E+094.65E+094.75E+094.37E+094.61E+09Sierra Leone8.49E+086.72E+086.69E+086.36E+087.49E+08Somalia..........Sudan1.06E+101.16E+101.07E+101.22E+101.36E+10Tanzania7.68E+098.38E+098.64E+099.08E+099.34E+09Togo1.50E+091.42E+091.42E+091.22E+091.26E+09Uganda6.27E+096.53E+095.97E+095.89E+095.64E+09Zambia3.91E+093.24E+093.13E+093.24E+093.64E+09Zimbabwe8.43E+095.73E+095.49E+097.20E+099.06E+09

Sheet5Health expenditure, public (% of total health expenditure)19971998199920002001Angola45.239.844.355.863.1Benin3436.538.643.346.9Burundi50.353.855.355.659Cameroon21.219.222.833.737.1Central African Republic37.944.44849.251.2Chad78.172.77578.776Comoros60.358.659.659.760Congo, Dem. Rep.47.141.741.544.744.4Congo, Rep.70.376.970.673.363.8Cote d'Ivoire1919.22015.416Equatorial Guinea63.16261.962.560.4Eritrea65.866.167.667.265.1Ethiopia37.939.337.734.540.5Gambia, The47.242.946.946.849.4Ghana47.653.853.955.959.6Guinea56.351.455.353.454.1Guinea-Bissau43.244.548.555.353.8Kenya21.724.118.723.821.4Lesotho7678.380.980.878.9Liberia69.173.476.576.275.9Madagascar78.464.458.564.865.9Malawi35.635.537.836.935Mali43.337.532.638.938.6Mauritania74.571.171.973.572.4Mozambique60.5626466.667.4Niger41.74343.643.139.1Nigeria11.715.41614.123.2Rwanda48.851.35452.955.5Sao Tome and Principe66.767.967.967.867.7Senegal54.857.556.156.658.8Sierra Leone46.844.253.860.461Somalia45.546.14544.844.6Sudan19.624.422.928.718.7Tanzania45.947.143.447.146.7Togo50.259.662.848.748.6Uganda29.13840.956.157.5Zambia55.156.954.852.553.1Zimbabwe59.155.948.950.745.3

Sheet6