James Droop
16 March 2010
DFID and the Health MDGs
Page 2
• 1.C: Halve, between 1990 and 2015, the proportion of people who suffer from hunger (Prevalence of underweight children under-five years of age)
• 4: Reduce by two-thirds, between 1990 and 2015, the under-five mortality rate
• 5.A: Reduce by three quarters, between 1990 and 2015, the maternal mortality ratio. B: Achieve, by 2015, universal access to reproductive health
• 6.A: Have halted by 2015 and begun to reverse the spread of HIV/AIDS. B: Achieve, by 2010, universal access to treatment for HIV/AIDS for all those who need it. C: Have halted by 2015 and begun to reverse the incidence of malaria and other major diseases
Page 3
DFID health spend by types of aid 2008/09 (provisional data)
Source: DFID, Health Portfolio Review 2009
General budget support£56.8m
Sector budget support£133.4m
Other financial
aid£121.1m
DFID Health Portfolio£1008.9m
Multilateral
£242.8m
Bilateral programmes
£766.2m
Financial aid £311.3m
Technical cooperation
£131.3m
Other bilateral aid£323.6m
Multilateral orgs.
£142.2m
Not for profit orgs.
£144.3m
Human-itarian£22.0m
Other
£1.5m
Debt relief
£13.6m
25 x increase 02/03 - 08/09 (2% to 17% bilateral aid)
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ODA Commitments for Health (1995-2008)
Source: OECD/DACNote: RH includes population policy and administrative management, reproductive health care, family planning, personnel development for population and reproductive health
ODA Commitments for Nutrition, 1995-2007
HIV/AIDS
Total Health
RH0500
0100
00
150
00
200
00
con
sta
nt
US
$ m
illions
1995 1998 2001 2004 2007Year
Total ODA Commitments for Health1995-2008
HIV/AIDS
Total Health
RH0500
0100
00
150
00
200
00
con
sta
nt
US
$ m
illions
1995 1998 2001 2004 2007Year
ODA Commitments for Health, 1995-200860 High MMR Countries: Ratio>300
Source: OECD DACNote:RH includes population commitments
ODA Commitments for Health, 1995-2008
Page 17
Maternal Mortality v. Fertility
Belize
Botswana
EthiopiaNigeria
Chad
Uganda
Ukraine
Brazil
Mali
Niger
China
IndonesiaIndia
Mexico
Poland
Bangladesh
Egypt
55010
022
050
015
00
Mate
rnal m
ort
ality
ratio
(M
MR
)
1 1.5 2 2.5 3 4 5 6 7Total fertility rate (TFR)
Source: WDINote: Median TFR=3; Median MMR=220Note: Colors mark HIV prevalence among females aged 15-24Red=high prevalence (greater than 1.3%)Yellow=middle prevalence (between 0.3% and 1.3%)Green=low prevalence (less than 0.3%)
Maternal mortality vs fertility in developing countries, 2005
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Health Financing:Needs and Resources
If commitments met and GDP growth continues – no gap (when aggregated across countries)
If stay at current levels of DAH – gap $28bn – $37bn by 2015
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2007 DFID Health Strategy
• Increasing the amount and improving the use of resources for health
• Expanding access to basic services through stronger systems
• Improving effectiveness of multilateral system
• Demonstrating results and improving evidence
• £7bn health spend 2008/15 (£1009m 08/09)
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White Paper 4
Page 23
AIDS Strategy
• Between 2004-2008 over £1.5 billion to support the global AIDS response - second largest donor after the US.
• £1 bn for the Global Fund for 2008-2015. £6 bn over 7 years for health
• A 50% increase in funding for research and development of AIDS vaccines and microbicides
• Stronger health systems to facilitate the scale up of preventative measures, such as prevention of mother to child transmission of HIV, help more effectively address co-morbidity of HIV with TB, malaria and other diseases and they will help deliver ARVs to those who need them.
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DFID and Global Health
• £7bn Commitment to health 2008 – 2015• £1bn to GFTAM
• Policy engagement• Strong health systems and coordination focus• Board membership - GFATM, GAVI and UNITAID
• Primary spend through bilateral programmes
• Significant funding to GHIs and multilaterals• EC, WB, GFATM, UNITAID, GAVI and UNFPA
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Health systems *36%
HIV/AIDS including STD Prevention
22%
Infectious diseases16%
Health Research7%
Maternal and Neonatal Health8%
Other5%
Reproductive Health Care6%
Bilateral Spend: sub-sectors (provisional data)
Source: DFID, Health Portfolio Review 2009
Page 26
DFID health spend by types of aid 2008/09 (provisional data)
Source: DFID, Health Portfolio Review 2009
General budget support£56.8m
Sector budget support£133.4m
Other financial
aid£121.1m
DFID Health Portfolio£1008.9m
Multilateral
£242.8m
Bilateral programmes
£766.2m
Financial aid £311.3m
Technical cooperation
£131.3m
Other bilateral aid£323.6m
Multilateral orgs.
£142.2m
Not for profit orgs.
£144.3m
Human-itarian£22.0m
Other
£1.5m
Debt relief
£13.6m
25 x increase 02/03 - 08/09 (2% to 17% bilateral aid)
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DFID Imputed Multilateral Spend on Health 2008/09 (provisional data)
Note: DFID counts GAVI and UNITAID as bilateral spendSource: DFID, Health Portfolio Review 2009
DFID Health Portfolio£1008.9m
Bilateral£766.2m
Multilateral£242.8m
United Nations
£57.1
GFATM£50.0m
IFFIm£16.8m
UNICEF£7.3m
UNFPA£25.0m
UNAIDS£10.0m
WHO£13.0m
UNDP£1.8m
WB£56.5m
EC£57.8m
RegionalBanks£4.6m
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Health Systems Spend Health aid by sub sector
0% 20% 40% 60% 80% 100%
UnitedKingdom
Multilateral
Bilateral
All
General health
TB Malaria and otherinfectious diseases
Other basic health
HIV/AIDs control
Other reproductive health
Source: OECD DAC data
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THE UK IS READY TO STAND WITH COUNTRIES READY TO PROVIDE FREE HEALTHCARE AND IN ADDITION TO PROVIDING RESOURCES, THE UK WILL ALSO SHARE OUR EXPERTISE. SO I AM NOW ANNOUNCING THE CREATION OF A NEW CENTRE FOR PROGRESSIVE HEALTH FINANCE - TO PROVIDE DEDICATED ADVICE FOR COUNTRIES WHO HOPE TO ABOLISH USER FEES AND MOVE FORWARD TO FREE HEALTHCARE.
DURING THE 1980S FLAWED DEVELOPMENT POLICIES AND BAD ADVICE LED MANY POOR COUNTRIES TO CHARGE FEES. THESE FEES – OFTEN ONLY A FEW PENCE – HAVE BECOME A DEATH SENTENCE FOR MILLIONS.
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International Engagement
More Money for Health, More Health for the Money
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Source; Don De Savigny & COHRED
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Contra-ceptives and
RHequipm ent
STIDrugs
EssentialDrugs
Vaccinesand
Vitamin ATB/Leprosy
BloodSafety
Reagents(inc. HIV
tests)
DFID
KfW
UNICEF
JICA
GOK, W B/IDA
Source offunds for
commodities
CommodityType
(colour coded) M OHEquip-ment
Point of firstwarehousing
KEM SA Central W arehouse
KEM SARegionalDepots
Organizationresponsible
for delivery todistrict levels
KEM SA and KEM SA Regional Depots (essential drugs, m alaria drugs,
consum able supplies)
ProcurementAgent/Body
Crow nAgents
Governmentof Kenya
GOK
GTZ(p rocurem ent
im plem entationunit)
JSI/DELIVER/KEM SA LogisticsM anagement Unit (contraceptives,
condom s, STI kits, HIV test kits, TBdrugs, RH equipm ent etc)
EU
KfW
UNICEF
KEPI ColdStore
KEPI(vaccines
andvitam in A)
M alaria
USAID
USAID
UNFPA
EUROPA
Condom sfor STI/
HIV/AIDSprevention
CIDA
UNFPA
USGov
CDC
NPHLS store
M EDS(to M issionfacilities)
PrivateDrug
Source
GDF
Governm ent
NGO/Private
Bilateral Donor
M ultilateral Donor
W orld Bank Loan
Organization Key
JapanesePrivate
Com pany
WHO
GAVI
SIDA
NLTP(TB/
Leprosydrugs
Com modity Logistics System in Kenya (as of April 2004) Constructed and produced by Steve Kinzett, JSI/Kenya - please communicateany inaccuracies to skinzett@ cb.jsikenya.com or telephone 2727210
Anti-RetroVirals
(ARVs)
Labor-atorysupp-
lies
GlobalFund forAIDS, TB
and M alaria
The"Consortium "
(Crow n Agents,GTZ, JSI and
KEMSA)
BTC
M EDS
DANIDA
M ainly District level staff: DPHO, DPHN, DTLP, DASCO, DPHO, etc or staff from the Health Centres,Dispensaries come up and collect from the District level
M EDS
Provincial andDistrict
HospitalLaboratory
Staff
Organizationresponsible fordelivery to sub-
district levels
KNCV
M SF
M SF
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International Health Partnership (IHP+)
"To work together in more efficient ways to improve health care and health outcomes…
Led by country governments acting with their civil society we will tackle the challenges facing country health systems….
To build on and use the existing systems at country level…
To be held to account in implementing this compact"
Global Compact, September 2007