Because health equity is a priority WHO Expert Group on R&D Financing: Geneva, 12-14 January 2009 Tracking Financial Resources for Health R&D Stephen Matlin

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


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


Resources for health R&D are situated in the domains of:

1. development cooperation (ODA)

2. health

3. research


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



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.



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


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.


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


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

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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)


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


OECD 2005: www.oecd.org/dataoecd/34/26/36418606.pdf


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



Commitment to Development Index 2007

www.cgdev.org

Quality-adjusted aid


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


Bilateral Donor Support to Tanzania, 2000-2002

Foreign Policy, Ranking the Rich 2004


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


Economist 11 October 2008


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


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


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


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


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


World health expenditures: US$ 4.4 trillion in 2005

www.who.int/nha/pie_chart_%202005.pdf

2. Health


Total Expenditure on Health 2003

0

200

400

600

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1000

1200

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1600

1800G

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any

Fra

nce

Un

ited

Kin

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Bel

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Sw

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Sw

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Den

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Cze

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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.


Targets

2001 Abuja Declaration on HIV/AIDS, TB and other related infectious diseases15% of domestic public spending to go on health

2. Health


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


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


Health R&D and national R&D as a % of GDP (2005)

0.0 1.0 2.0 3.0 4.0

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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


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


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



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

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80

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100

AFRO AMRO EMRO EURO SEARO WPRO

%


'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


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'


Total Gates Foundation Grants by Disease (to 2005)

‘Very neglected diseases'


Fragmentation in international effort ….


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


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


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


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


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






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%


Documents

Because health equity is a priority WHO Expert Group on R&D Financing: Geneva, 12-14 January 2009 Tracking Financial Resources for Health R&D Stephen Matlin