WHO Expert Group on R&D Financing: Geneva, 12-14 January
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WHO Expert Group on R&D Financing: Geneva, 12-14 January 2009 Tracking Financial Resources for Health R&D Stephen Matlin Executive Director Global Forum for Health Research Geneva. The spectrum of health research for development. Biomedical research. Health policy and systems research.

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WHO Expert Group on R&D Financing: Geneva, 12-14 January 2009 Tracking Financial Resources for Health R&D Stephen Matlin Executive Director

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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

Executive Director

Global Forum for Health Research

Geneva


Because health equity is a priority

The spectrum of health research for development

Biomedical research

Health policy and systems

research

Social sciences and

behavioural 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

Innovation

Impact


Because health equity is a priority


Because health equity is a priority

  • Targets: commitments and aspirations

  • e.g. Commitments

  • 1.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 1970

  • Reinforced: Monterrey Consensus on Financing for Development 2002

  • Timetables: by 2015, set by many EU countries since 2002

  • 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 in

  • Johannesburg 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 2005

Committed: 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. Aspirations

2.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 Countries

A-1National R&D total investment as a % GDP

A-2National R&D for health as % GDP

A-3National R&D for health as % national health investments

A-4National R&D for health as % total R&D

BHigh-income countries

B-1Gap between actual ODA and commitment to invest 0.7% of GNI on ODA

B-2Gap between actual annual increase in ODA and commitment to double aid between 2005 and 2010 - an extra $50 billion worldwide and $25 billion for Africa

B-3Gap between actual ODA investments in R&D for health and target to invest 5% of health ODA in R&D for health

CLow- and Middle-income Countries

C-1Gap between actual investments in health and target to spend 15% of domestic public spending on health

C-2Gap between actual investments in R&D for health and target to spend 2% of national health budgets on health research

DGlobal Health Initiatives and development agencies

D-1Gap 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 Monterrey

  • 0.7% 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

Intramural researchers

Intramural researchers

Intramural researchers

Researchers worldwide

Development cooperation (ODA)

Central government

Bilateral ODA

Multilateral ODA

Other government

agencies (host country,

transitional developing countries)

Ministries

Development cooperation agencies

Specialized research agencies

UN Agencies

The World Bank Group

Regional Development Banks EC

Voluntary

contributions

Universities

Research institutions

Research councils

Nongovernmental organizations

Foundations/charities/trusts

Companies

Partnerships/Initiatives

Public-private partnerships


Because health equity is a priority

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

Comparison of 2005 ODA to the 0.7% of GNI target, for the G7 Countries

Global Forum for Health Research, Monitoring Financial Flows for Health Research, 2008


Because health equity is a priority

Quality-adjusted aid Countries

Commitment to Development Index 2007

www.cgdev.org


Aid flows
Aid flows Countries

2002

$58 billion total aid flows from rich countries to poor ones

2000 - 2002 new aid project commitments

Mozambique 1,413

India 1,339

China 1,328

Tanzania1,371

2003

Tanzania declared a four-month “mission holiday”, receiving only the most urgent visits by donors

Foreign Policy, Ranking the Rich 2004


Bilateral donor support to tanzania 2000 2002
Bilateral Donor Support to Tanzania, 2000-2002 Countries

Foreign Policy, Ranking the Rich 2004


Because health equity is a priority

Paris Declaration on Aid Effectiveness Countries Ownership, Harmonisation, Alignment, Results and Mutual AccountabilityHigh Level Forum, Paris: 28 February – 2 March 2005

  • We reaffirm the commitments made at Rome to harmonise and align aid delivery….

  • especially in the following areas:

  • Strengthening partner countries’ national development strategies and associated operational frameworks

  • 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



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


What happens to aid following financial crises
What happens to aid following financial crises… financial crisis

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 crises1
What happens to aid following financial crises… financial crisis

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 financial crisis

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 financial crisis

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

2.Health financial crisis

World health expenditures: US$ 4.4 trillion in 2005

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


Because health equity is a priority

Health expenditures: 2003 financial crisis


Because health equity is a priority

Land area financial crisis

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

2.Health financial crisis

Targets

2001 Abuja Declarationon HIV/AIDS, TB and other related infectious diseases

15% of domestic public spending to go on health


Because health equity is a priority

3.Research financial crisis

Targets

2002 European Union

Spend total of 3% of GDP on R&D by 2010

2003 African Union/NEPAD

Increase public spending on R&D to at least 1% of GDP within five years

1990 Commission on Health Research for Development

2% 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) financial crisis

EU 3% target

AU 1% target


Because health equity is a priority

Strength of investments in health R&D (2005) financial crisis

2% target

for LMICs


Because health equity is a priority

Global health R&D expenditures financial crisis

Global Forum for Health Research, Monitoring Financial Flows for Health Research, 2008


Because health equity is a priority

Group I financial crisis

Communicable, maternal, perinatal and nutritional conditions

100

%

Group 2

Non-communicable diseases

90

80

70

Group 3

Injuries

60

50

40

30

20

10

0

AFRO

AMRO

EMRO

EURO

SEARO

WPRO

Globalization of disease burdens

Deaths by cause and WHO region, 2002


Because health equity is a priority

'Neglected Diseases' financial crisis

  • 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

'Neglected Diseases' financial crisis

  • 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


Because health equity is a priority

‘Very neglected diseases' financial crisis

Total Gates Foundation Grants by Disease (to 2005)



Diseases that disproportionately affect lmics
Diseases that disproportionately affect LMICs financial crisis

  • 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 epidemic financial crisis Cancer, 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 diabetics

    India32 million

    China21 million

    USA18 million

    Indonesia 8 million

    2000 global total:over 170 million

    Estimated 2030 total: over 360 million


Because health equity is a priority

Obesity rate doubles in 10 years in China financial crisis

•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)



Because health equity is a priority
Chronic diseases: the new epidemic financial crisis Cancer, 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

Global health R&D expenditures financial crisis

Global Forum for Health Research, Monitoring Financial Flows for Health Research, 2008


Because health equity is a priority

Global health R&D expenditures financial crisis

180

HICs 98%

USA 47%

NCDs > 90%

160.3

160

140

51%

private

HICs 95%

USA 53%

NIH 43%

of global publicR&D, of which

NCDs 50-60%

120

41%

public

100

Health R&D expenditure

8%

not

80

for

profit

60

HICs 96%

NCDs ?%

40

20

0

1986

1992

1998

2001

2003

2005

Year

Global Forum for Health Research, Monitoring Financial Flows for Health Research, 2008


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