Development assistance for health to the occupied Palestinian territory from 1990 to 2008: a database analysis

Abstract

Background Since the Oslo Accords in 1993, there has been a gradual increase, becoming steep from 2005, in development assistance to the occupied Palestinian territory (oPt). In this study, I aimed to provide a systematic assessment of the scale, focus, and trends in regional and global development assistance for health (DAH) to the oPt from 1990 to 2008. Methods Using the DAH country and regional recipient database of the Institute for Health Metrics and Evaluation, Seattle, WA, USA, published reports, and the database for creditor reporting system of the Organisation for Economic Co-operation and Development, a database was created for the DAH to the oPt and other Arab countries. All disbursements are reported in 2008 US$. Findings DAH to the oPt increased from $74 000 in 1990 to $62 million in 2008. The total DAH to the oPt during these years was $524 million, representing 5·3% of the total development assistance to the oPt. The DAH per person to the oPt is the highest in the Arab countries, with a mean $7·94 per year since 1990, and peaking at $16·35 in 2004 (appendix). In the oPt, 92·5% of the total DAH to the oPt from 1990 to 2008 was not earmarked for specific diseases. The USA is the largest donor of DAH to the oPt, contributing 36·9% of $524 million total DAH from 1990 to 2008. The geographic distribution of aid within the oPt is not yet known, though preliminary evidence suggests a higher flow of aid per person to the West Bank than to the Gaza Strip. These amounts do not include the UN Relief and Works Agency for Palestine Refugees in the Near East's health spending in the oPt because yearly health spending within the oPt is not reported, though is roughly estimated to be $9·5 per person since 2002 on the basis of previous reports (appendix). The amounts reported here do not include general budget support to the Palestinian Authority of about $400 million from 2001 to 2005, rising rapidly to $1·6 billion by 2008. The Palestinian Authority claims to spend 10% of the budget support on health ($38 per person in 2008), but because these amounts could not be verified they have not been included in this analysis. Interpretation Although the oPt has received more DAH per person since 1990 than has any of the Arab countries, we do not know the effect of DAH on health outcomes in the oPt. Total official development assistance per person and DAH per person have continued to increase, led by contributions from the USA. The reporting of contributions of DAH to the oPt by Muslim and Arab countries through formal international channels have been neither meaningful nor consistent. Measurement of the effect and distribution of DAH to the oPt could be improved through better adherence to global guidelines for monitoring and accountability of aid, including the Paris Declaration. Funding Freeman Spogli Institute's Global Underdevelopment Action Fund (Stanford University).