The financing gaps framework: using need, potential spending and expected spending to allocate development assistance for health

Abstract

As growth in development assistance for health levels off, development assistance partners must make allocation decisions within tighter budget constraints. Furthermore, with the advent of comprehensive and comparable burden of disease and health financing estimates, empirical evidence can increasingly be used to direct funding to those most in need. In our 'financing gaps framework', we propose a new approach for harnessing information to make decisions about health aid. The framework was designed to be forward-looking, goal-oriented, versatile and customizable to a range of organizational contexts and health aims. Our framework brings together expected health spending, potential health spending and spending need, to orient financing decisions around international health targets. As an example of how the framework could be applied, we develop a case study, focused on global goals for child health. The case study harnesses data from the Global Burden of Disease 2013 Study, Financing Global Health 2015, the WHO Global Health Observatory and National Health Accounts. Funding flows are tied to progress toward the Sustainable Development Goal's target for reductions in under-five mortality. The flexibility and comprehensiveness of our framework makes it adaptable for use by a diverse set of governments, donors, policymakers and other stakeholders. The framework can be adapted to short- or long-run time frames, cross-country or subnational scales, and to a number of specific health focus areas. Depending on donor preferences, the framework can be deployed to incentivize local investments in health, ensuring the long-term sustainability of health systems in low- and middle-income countries, while also furnishing international support for progress toward global health goals.

Keywords: Overseas development assistance; aid; resource allocation.

Figure 1

Representation of expected trend and trajectory necessary to meet international health goal

Figure 2

Comparing expected spend, potential spend and need

Figure 3

Potential and expected spending on child health for the 10 countries with the most need

Figure 4

Resources needed and potential and expected spending on child health for the 10 countries with the most need

Figure 5

GDP per capita vs the gap between resources needed and expected government spending on child health (Gap A + Gap B)

Figure 6

Gap between need and expected government spending on child health (Gap A + Gap B) vs the gap between need and potential government spending on child health (Gap A)

Figure 7

Unadjusted child mortality vs the gap between need and potential government spending on child health (Gap A)