Tracking global development assistance for trauma care: A call for advocacy and action

Abstract

Background: This study aimed to track development assistance for trauma care (DAH-TC), uncover funding trends and gaps, and compare DAH-TC to development assistance for other health conditions.

Methods: A systematic search of the OECD Creditor Reporting System (CRS) and Development Assistance Committee (DAC) databases was performed to capture projects related to trauma care. Reports from large foundations and public-private partnerships were also searched. DAH-TC was described, and comparisons were made between DAH-TC and other health conditions.

Results: The search yielded 1754 records; after applying exclusion criteria, 301 records were included for analysis. During the 25-year period, US$93.7M of DAH-TC was disbursed to low- and middle-income countries (LMICs) (0.02% of total DAH). Contributions were dominated by a few donors and fluctuated dramatically over time. A sizable portion of DAH-TC came in the form of investments to build infrastructure (38% of DAH-TC); information and research activities (17%); and training (16%). Nearly US$58M (62% of DAH-TC) was funneled to projects that targeted victims of war. Trauma care received US$0.04 per DALY incurred, while malaria, TB, HIV and MCH received US$9.62 per DALY, US$25.09 per DALY, US$4.05 per DALY and US$45.75 per DALY, respectively.

Conclusions: DAH-TC is critically underfunded, particularly compared to other health foci. To improve the DAH-TC landscape, stakeholders can better mobilize domestic resources; use advocacy more effectively by catalyzing network convergence, grafting trauma care onto related high-priority issues, and seeking broader coalitions; and develop partners within the donor and channel communities to promote strategic DAH-TC disbursements.

Figure 1

Flow diagram for systematic search trauma-related disbursements.

Figure 2

Total disbursements in the global development assistance for trauma care (DAH-TC) from 1990- 2015. USD – United States Dollars.

Figure 3

Donors in the global development assistance for trauma care (DAH-TC) landscape from 1990- 2015. USD – United States Dollars, EU – European Union.

Figure 4

Financing flow depicting the donors and channels for global development assistance for trauma care (DAH-TC) from 1990- 2015. NGO – non-governmental organization, Univ. – university, UN – United Nations.

Figure 5

Global development assistance for trauma care (DAH-TC) recipients from 1990-2015. USD – United States Dollars, Recipients listed in descending value of DAH-TC: Iraq 18.13, Albania 6.23, Lebanon 5.68, Afghanistan 4.10, Cambodia 3.96, Syrian Arab Republic 3.43, Haiti 3.21, China (People's Republic of) 2.83, Bangladesh 2.66, Uganda 2.27, Angola 2.15, Ethiopia 2.07, Botswana 1.89, Sri Lanka 1.66, Bosnia and Herzegovina 1.64, Democratic Republic of the Congo 1.29, Jordan 1.17, Viet Nam 0.98, South Africa 0.96, Croatia 0.83, Pakistan 0.76, Sierra Leone 0.68, Egypt 0.64, Lao People's Democratic Republic 0.59, Libya 0.54, Yemen 0.52, Papua New Guinea 0.52, Tanzania 0.48, Nicaragua 0.43, Morocco 0.41, Malawi 0.39, Nepal 0.34, Mozambique 0.33, Guinea-Bissau 0.30, Honduras 0.29, Mali 0.28, Liberia 0.24, Kyrgyzstan 0.20, Eritrea 0.19, Burundi 0.17, Indonesia 0.15, Myanmar 0.14, Bhutan 0.14, Rwanda 0.10, Azerbaijan 0.10, India 0.10, Georgia 0.09, Namibia 0.09, Mongolia 0.08, Colombia 0.07, Thailand 0.05, Algeria 0.05, Kenya 0.05, Guatemala 0.03, Senegal 0.01, Tunisia 0.01.

Figure 6

Comparison between 2013 injury mortality rates and development assistance for trauma care (DAH-TC) disbursements from 2000-2015. Injury mortality and development assistance for trauma care (DAH-TC) rankings are 2012 population adjusted; green – high-income countries; blue – upper-middle income countries; orange – lower-middle income countries; red – low-income countries.

Figure 7

Median global development assistance for trauma care (DAH-TC) per disability-adjusted life year (DALY). USD – United States Dollars.