By Jesse Bump (Harvard University)
Who gets what in global health? Through what processes or according to what measures? Any ideas? Billions of lives are affected by these decisions and yet Global health aid is allocated through opaque processes using criteria that are not always disclosed, and leads to results that are not widely available. This is completely unfair to all concerned and represents a major challenge to the accountability and legitimacy of multilateral agencies. The very limited participation of Low- and Middle-Income Countries (LMICs) is a further breech of the humanitarian principles that underlie international assistance. But perhaps the most glaring feature of allocation is that Gross National Income per capita (GNIpc) is always at the center of it. GNIpc has long been used for this purpose, but this metric is unreliable in many LMICs. Even when accurate, it is a spectacularly poor measure of actual need, which should be at the core of decision-making.
Through this special issue ‘Beyond Gross National Income: Innovative methods for global health aid allocation’ we launch a discussion around how allocation is done now and how it can be improved. We analyze allocation practices at nine major multilateral agencies in global health and provide new empirical evidence on how to improve it. We examine fundamental values and preferences of global health professionals to reveal the normative basis for aid. We test GNIpc against actual disease burden to check the validity of using GNIpc as a proxy for health needs, and we assess the effect of combining it with other indicators. We also explore ways to forecast resource requirements, measure health financing gaps, and examine sustainability.
We argue that countries needing global health assistance should demand better in each of these areas. More transparency and equity around the processes. Empirically better metrics and criteria. Greater clarity on resource mobilization responsibilities and sustainable financing. More participation by recipient countries and citizens.
Articles in the supplement
- Editorial (Jesse Bump) Global Health Aid Allocation in the 21st Century
- Original article (Y-Ling Chi and Jesse Bump) Resource Allocation Processes At Multilateral Organisations Working In Global Health
- Original article (Olivier Sterck et al) Allocation of development assistance for health: is the predominance of national income justified?
- Original article (Karen Grépin et al) Allocating external financing for health: a discrete choice experiment of stakeholder preferences
- Original article (Trygve Ottersen et al) New approaches to ranking countries for the allocation of development assistance for health: choices, indicators, and implications
- Original article (Annie Haakenstad et al) The financing gaps framework: using need, potential spending and expected spending to allocate development assistance for health