because health equity is a priority who expert group on r&d financing: geneva, 12-14 january...
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because health equity is a priority
WHO Expert Group on R&D Financing: Geneva, 12-14 January 2009
Tracking Financial Resourcesfor
Health R&D
Stephen Matlin
Executive DirectorGlobal Forum for Health Research
Geneva
because health equity is a priority
Biomedical research Health policy and systemsresearch
Social sciences andbehavioural research
Operational research
Understanding the biological nature of diseases; creating
products to prevent or treat disease states
Understanding how to test, scale-up and follow through the introduction of interventions and optimize their benefits
InnovationImpact
The spectrum of health research for development
because health equity is a priority
Resources for health R&D are situated in the domains of:
1. development cooperation (ODA)
2. health
3. research
because health equity is a priority
Targets: commitments and aspirations
e.g. Commitments1. Each economically advanced country will progressively increase its
official development assistance to the developing countries and will exert its best efforts to reach a minimum net amount of 0.7 per cent of its gross national product at market prices by the middle of the decade.
Adopted: UN General Assembly 1970Reinforced: Monterrey Consensus on Financing for Development
2002Timetables: by 2015, set by many EU countries since 2002
2. Ministers of S&T of 20 African countries reaffirmed their commitment to increasing public spending on R&D to at least 1% of GDP within five years.
Adopted: First NEPAD Ministerial Conference on S&T:Declaration and Outline of a Plan of Action adopted inJohannesburg on 3-7 November 2003
because health equity is a priority
Targets: commitments and aspirations
e.g. Aspirations ( Commitments)1. LMICs should aim to spend 2% of their government health budgets on
health research and research capacity strengthening; this should be complemented by donors committing 5% of their health aid similarly.
Recommended: Commission on Health Research for Development 1990 Reinforced: Mexico Ministerial Summit on Health Research 2004
and WHA 2005Committed: We, ministers of health and heads of delegation of the
African countries, meeting in Algiers on 26 June 2008 for the Ministerial Conference on Research for Health in
Africa… commit ourselves to launching before the end of 2009 the actions that follow:
j. Allocate at least 2% of national health expenditures and at least 5% of health external project and programme aid to research and research capacity building; and invest
more on research aimed at improving health systems.
because health equity is a priority
Targets: commitments and aspirations
e.g. Aspirations2. The Ministers of Health and Heads of Delegation (of 14 African
countries) urge:9.iii Global Health Initiatives and development agencies to devote at least 5% of their overall health investment portfolio to support research capacity of countries, dissemination of research findings and management of knowledge.
Recommended: Accra Communiqué: High Level Ministerial Meeting on Health Research for Disease Control and Development. Accra, Ghana 17th June 2006
because health equity is a priority
Report Card for R&D for Health
A All CountriesA-1 National R&D total investment as a % GDP A-2 National R&D for health as % GDP A-3 National R&D for health as % national health investments A-4 National R&D for health as % total R&D
B High-income countriesB-1 Gap between actual ODA and commitment to invest 0.7% of GNI on ODAB-2 Gap between actual annual increase in ODA and commitment to double aid
between 2005 and 2010 - an extra $50 billion worldwide and $25 billion for AfricaB-3 Gap between actual ODA investments in R&D for health and target to invest 5% of
health ODA in R&D for health
C Low- and Middle-income Countries C-1 Gap between actual investments in health and target to spend 15% of domestic
public spending on healthC-2 Gap between actual investments in R&D for health and target to spend 2% of
national health budgets on health research
D Global Health Initiatives and development agenciesD-1 Gap between actual investments and target to invest 5% of overall health
investment portfolios of Global Health Initiatives and development agencies to support research capacity of countries, dissemination of research findings, and management of knowledge.
because health equity is a priority
1. Development cooperation (ODA)
Targets
1970 UN, 2002 Monterrey0.7% of GNP/GNI on ODA
2005 Gleneagles G8 Summit Doubling of aid by 2010:-an extra $50 billion per year worldwide and $25 billion per year for Africa, compared with 2004
because health equity is a priority
Net ODA (2002)
0
2
4
6
8
10
12
14
Fran
ce
Ger
man
y
Uni
tedK
ingd
om
Net
herla
nds Ita
ly
Swed
en
Spai
n
Nor
way
Den
mar
k
Bel
gium
Switz
erla
nd
Aus
tria
Finl
and
Irela
nd
Port
ugal
Gre
ece
Uni
tedS
tate
s
Japa
n
Can
ada
Aus
tral
ia
New
_Zea
land
US$
bill
ions
ODA spending by country
Central government
Bilateral ODA Multilateral ODA
Other governmentagencies (host country,transitional developing
countries)
UN AgenciesThe World Bank Group
Regional Development Banks EC
Intramural researchers
Voluntarycontributions
MinistriesDevelopment cooperation
agenciesSpecialized research agencies
Intramural researchers Intramural researchers
Researchers worldwide
UniversitiesResearch institutions
Research councilsNongovernmental organizations
Foundations/charities/trustsCompanies
Partnerships/InitiativesPublic-private partnerships
Development cooperation (ODA)
because health equity is a priority
0.00
0.10
0.20
0.30
0.40
0.50
1980 1985 1990 1995 2000 2005
OD
A a
s %
of
GN
I
0
20
40
60
80
100
OD
A (
2006
US
$ b
illio
n)
ODA as a % of GNI ODA (2006 US$ billion)
DAC members’ total ODA from 1980 in 2006 US$ and as a share of GNI
Global Forum for Health Research, Monitoring Financial Flows for Health Research, 2008
because health equity is a priority
OECD 2005: www.oecd.org/dataoecd/34/26/36418606.pdf
because health equity is a priority
Comparison of 2005 ODA to the 0.7% of GNI target, for the G7 Countries
0 10 20 30 40 50 60 70 80 90
United States
Japan
United Kingdom
Germany
France
Italy
Canada
ODA (actual and target), in billions US$
ODA below target
Gap to target 0.7% GNI
Global Forum for Health Research, Monitoring Financial Flows for Health Research, 2008
because health equity is a priority
Commitment to Development Index 2007
www.cgdev.org
Quality-adjusted aid
because health equity is a priority
2002 $58 billion total aid flows from rich countries to poor ones
2000 - 2002 new aid project commitmentsMozambique 1,413 India 1,339China 1,328Tanzania 1,371
2003Tanzania declared a four-month “mission holiday”, receiving only the most urgent visits by donors
Aid flows
Foreign Policy, Ranking the Rich 2004
because health equity is a priority
Bilateral Donor Support to Tanzania, 2000-2002
Foreign Policy, Ranking the Rich 2004
because health equity is a priority
We reaffirm the commitments made at Rome to harmonise and align aid delivery….especially in the following areas:i. Strengthening partner countries’ national development strategies and associated
operational frameworks ii. Increasing alignment of aid with partner countries’ priorities, systems and procedures
and helping to strengthen their capacities.iii. Enhancing donors’ and partner countries’ respective accountability to their citizens and
parliaments for their development policies, strategies and performance.iv. Eliminating duplication of efforts and rationalising donor activities to make them as cost-
effective as possible.v. Reforming and simplifying donor policies and procedures to encourage collaborative
behaviour and progressive alignment with partner countries’ priorities, systems and procedures.
vi. Defining measures and standards of performance and accountability of partner country systems in public financial management, procurement, fiduciary safeguards and environmental assessments, in line with broadly accepted good practices and their quick and widespread application.
www.oecd.org/dataoecd/11/41/34428351.pdf
Paris Declaration on Aid EffectivenessOwnership, Harmonisation, Alignment, Results and Mutual Accountability
High Level Forum, Paris: 28 February – 2 March 2005
because health equity is a priority
Economist 11 October 2008
because health equity is a priority
UN chief urges donors to honour aid pledges despite financial crisis
UN Secretary-General Ban Ki-moon expressed deep concern on Tuesday at the continuing financial crisis, urging donor countries to honour their commitments to helping the world's poorest people despite difficulties caused by the crisis.
Echoing a similar concern raised by World Bank President Robert Zoellick, Ban stressed that leaders of the Group of Eight industrialized countries had committed to providing annually 50 billion U.S. dollars for the purpose of helping developing countries in the 2005 Gleneagles summit.
"Now because of all this changing prices, it has gone up to at least 62 billion dollars now," Ban said. "First of all, G8 countries should implement their commitment."
Xinhua, 8 October 2008
because health equity is a priority
What happens to aid following financial crises…
David Roodman, Center for Global Development, 13 October 2008. http://blogs.cgdev.org/globaldevelopment/2008/10/history_says_financial_crisis.php
because health equity is a priority
What happens to aid following financial crises…
David Roodman, Center for Global Development, 13 October 2008. http://blogs.cgdev.org/globaldevelopment/2008/10/history_says_financial_crisis.php
because health equity is a priority
Total Health ODA 2001-2006
OECD-DAC Database: ‘Health ODA’ aggregates three Creditor Reporting System sectors: (1) Health (2) Population Policies/Programmes & Reproductive Health (3) Water Supply/Sanitation
Kaiser Family Foundation www.kff.org/hivaids/upload/7679_02.pdf
because health equity is a priority
Health ODA Commitments by Major Sub-Sector, 2006
2.8% of total health ODA
4.4% of (1) and (2)
OECD-DAC Database: ‘Health ODA’ aggregates three Creditor Reporting System sectors: (1) Health (2) Population Policies/Programmes & Reproductive Health (3) Water Supply/Sanitation
Kaiser Family Foundation www.kff.org/hivaids/upload/7679_02.pdf
because health equity is a priority
World health expenditures: US$ 4.4 trillion in 2005
www.who.int/nha/pie_chart_%202005.pdf
2. Health
because health equity is a priority
Total Expenditure on Health 2003
0
200
400
600
800
1000
1200
1400
1600
1800G
erm
any
Fra
nce
Un
ited
Kin
gd
om
Ital
y
Sp
ain
Net
her
lan
ds
Bel
giu
m
Po
lan
d
Sw
itze
rlan
d
Sw
eden
Gre
ece
Au
stri
a
Po
rtu
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No
rway
Den
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k
Cze
ch R
epu
blic
Hu
ng
ary
Ro
man
ia
Fin
lan
d
Irel
and
Slo
ven
ia
Icel
and
Slo
vak_
Rep
ub
lic
Un
ited
_Sta
tes
Jap
an
Can
ada
Au
stra
lia
New
_Zea
lan
d
US
$ b
illio
ns
Health expenditures: 2003
Land area
www.worldmapper.org
Public health spending
Territory size shows the proportion of worldwide spending on public health services that is spent there. This spending is measured in purchasing power parity.
because health equity is a priority
Targets
2001 Abuja Declaration on HIV/AIDS, TB and other related infectious diseases15% of domestic public spending to go on health
2. Health
because health equity is a priority
0 2 4 6 8 10 12 14 16 18 20
Algeria
Botswana
Cape Verde
Côte d'Ivoire
Egypt
Ethiopia
Ghana
Kenya
Libyan Arab J amahiriya
Mali
Mozambique
Nigeria
Senegal
Sudan
Tunisia
Zambia
Health as % government expenditure 2003
because health equity is a priority
3. Research
Targets2002 European UnionSpend total of 3% of GDP on R&D by 2010
2003 African Union/NEPADIncrease public spending on R&D to at least 1% of GDP within five years
1990 Commission on Health Research for Development2% of national health budgets of LMICs and 5% of aid for the health sector from development aid agencies should be earmarked for research and research capacity strengthening
because health equity is a priority
Health R&D and national R&D as a % of GDP (2005)
0.0 1.0 2.0 3.0 4.0
0.0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
1.0
1.1
0.0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
1.0
1.1
Austria
Belgium
Canada
Czech R.
Denmark
FinlandFrance
Germany
Greece
Hungary
Iceland
IrelandItaly
Japan
Korea
Luxembourg Mexico
Netherland
Norway
Poland Portugal
Slov ak R.
Spain
Sweden
Switzerland
Turkey
UK
USA
Argentina
ChinaRussia
Singapore
Slov enia
South Af rica
Brazil
CubaPanama
Trinidad
Total expenditure on R&D as % of GDP
Ex
pe
nd
itu
re o
n h
ea
lth
R&
D a
s %
of
GD
P
EU 3% targetAU 1% target
because health equity is a priority
0 5 10 15 20 25 30 35
0
1
2
3
4
5
6
7
8
9
10
11
Austria
Belgium
Canada
Czech R.
Denmark
Finland
France Germany
Greece
Hungary
Iceland
Ireland
Italy
Japan
Korea
Luxemb.Mexico
Netherland
Norway
Poland
Portugal Slov akia
Spain
Sweden
Switzerland
Turkey
UK
USA
Argentina China
Israel
Romania
Russia
Slov enia
South Af rica
Brazil
Cuba Panama
Trinidad
India
Venezuela
Health R&D as % of total R&D expenditure
He
alt
h R
&D
as
% o
f n
ati
on
al
he
alt
h e
xp
en
dit
ure
Strength of investments in health R&D (2005)
2% targetfor LMICs
because health equity is a priority
0
20
40
60
80
100
120
140
160
180
1986 1992 1998 2001 2003 2005
Year
Hea
lth
R&
D e
xp
end
itu
re
51% private
41% public
8% not for
profit
48% private
45% public
7% not for
profit
48% private
44% public
8% not for
profit
48% private
45% public
7% not for
profit
30
55.8
84.9
105.9
125.8
160.3
Global health R&D expenditures
Global Forum for Health Research, Monitoring Financial Flows for Health Research, 2008
because health equity is a priority
Deaths by cause and WHO region, 2002
Globalization of disease burdens
Group ICommunicable, maternal, perinatal and nutritional conditions
Group 2Non-communicable diseases
Group 3Injuries
0
10
20
30
40
50
60
70
80
90
100
AFRO AMRO EMRO EURO SEARO WPRO
%
because health equity is a priority
'Neglected Diseases'
Diseases:
• that are significant sources of mortality and morbidity
• for which there are few or no adequate interventions (that are relevant to large, affected populations)
• that attract relatively little R&D funding
because health equity is a priority
Mortality Estimates for 2002 (World Health Report 2004)
Infectious and Parasitic diseases 10 904 (000)
HIV/AIDS 2 777 ¨Diarrhoeal diseases 1 798 ¨Tuberculosis 1 566 ¨Malaria 1 272 ¨Childhood diseases 1 124 ¨STIs (excluding HIV) 180 ¨Meningitis 173 ¨(Other) Tropical Diseases 129 ¨Hepatitis B 103 ¨Hepatitis C 54 ¨Dengue 19 ¨Japanese encephalitis 14 ¨Intestinal nematodes 12 ¨Leprosy 6 ¨
African trypanosomiaisis
Chagas Disease
Leishmaniasis
Leprosy
Lymphatic filariasis
Onchocerciasis
Schistosomiasis
'Neglected Diseases'
because health equity is a priority
Total Gates Foundation Grants by Disease (to 2005)
‘Very neglected diseases'
because health equity is a priority
Fragmentation in international effort ….
because health equity is a priority
Diseases that disproportionately affect LMICs
• Type III Overwhelmingly or exclusively incident in developing countries
• Type II Incident in rich and poor countries but with a substantial
proportion of the cases in poor countries
• Type I Incident in both rich and poor countries, with large numbers of
vulnerable populations in each
because health equity is a priority
Chronic diseases: the new epidemicCancer, Diabetes, Heart Disease, Stroke, Mental/Neurological Conditions
• Becoming the dominant source of ill health and death in LMICs* Driven by: poor diet, lack of physical activity, tobacco use
• 57 million deaths in 2003: 33 million attributed to chronic diseases
• 17 million attributed to cardiovascular disease* 1/3 of these occurred in mid-aged people* 1/3 occurred in China and India
• Estimated number of diabeticsIndia 32 millionChina 21 millionUSA 18 millionIndonesia 8 million
2000 global total: over 170 millionEstimated 2030 total: over 360 million
because health equity is a priority
Obesity rate doubles in 10 years in China
• 60 million obese; 200 million overweight
• 20 million have diabetes
• 160 million have high blood pressure
First comprehensive Chinese national survey on diet, nutrition and disease; reported October 13, 2004 (270 000 adults surveyed)
City County
Rank Cause Death Rate (1/100000)
% Cause Death Rate (1/100000)
%
1 Malignant Neoplasms 126.42 23.92 Malignant Neoplasms 119.66 23.70
2 Cerebrovascular Disease
100.90 19.09 Cerebrovascular Disease 74.95 14.85
3 Heart Disease 99.36 18.80 Diseases of Respiratory System
67.18 13.30
4 Disease of Respiratory System
69.33 13.12 Heart Disease 63.36 12.54
5 Injury & Poisoning 31.14 5.89 Injury & Poisoning 33.50 6.63
6 Diseases of Digestive System
17.13 3.24 Diseases of Digestive System
14.21 2.81
7 Endocrine, Nutritional & Metabolic Diseases
14.91 2.82 Endocrine, Nutritional & Metabolic Diseases
12.74 2.52
8 Diseases of Genitourinary System
9.52 1.81 Disease of Genitourinary System
8.11 1.61
9 Disease of Nervous System
4.59 0.86 Disease Originating in the Perinatal Period (1/100,000 live birth)
363.95 0.68
10 Disease Originating in the Perinatal Period
168.46 0.52 Pulmonary Tuberculosis 3.25 0.64
Death rate & ranking of 10 main diseases in China, 2004
because health equity is a priority
Chronic diseases: the new epidemicCancer, Diabetes, Heart Disease, Stroke, Mental/Neurological Conditions
Research agenda for NCDs• relevant to health of the poor in LMICs• Needs to include a wide range of research domains
* Effectiveness of existing (generic) drugs with different genetic groups and in different settings
* New drugs that are cheaper/more appropriate for different populations and settings
* Treatment regimes and health care systems* Rapid, cheap, easy-to-use, robust diagnostics
because health equity is a priority
0
20
40
60
80
100
120
140
160
180
1986 1992 1998 2001 2003 2005
Year
Hea
lth
R&
D e
xp
end
itu
re
51% private
41% public
8% not for
profit
48% private
45% public
7% not for
profit
48% private
44% public
8% not for
profit
48% private
45% public
7% not for
profit
30
55.8
84.9
105.9
125.8
160.3
Global health R&D expenditures
Global Forum for Health Research, Monitoring Financial Flows for Health Research, 2008
because health equity is a priority
Global health R&D expenditures
Global Forum for Health Research, Monitoring Financial Flows for Health Research, 2008
0
20
40
60
80
100
120
140
160
180
1986 1992 1998 2001 2003 2005
Year
He
alt
h R
&D
ex
pe
nd
itu
re
51% private
41% public
8% not for
profit
160.3
HICs 96%
NCDs ?%
HICs 95%
USA 53%
NIH 43%of global publicR&D, of which
NCDs 50-60%
HICs 98%
USA 47%
NCDs > 90%
because health equity is a priority