Abstract
Health security funding is intended to improve capacities for preventing, detecting, and responding to public health emergencies. Recent years have witnessed substantial increases in the amounts of donor financial assistance to health security from countries, philanthropies, and other development partners. To date, no work has examined the effects of assistance on health security capacity development over time. This paper presents an analysis of the time-lagged effects of assistance for health security (AHS) on levels of capacity. We collected publicly available health security assessment scores published between 2010 and 2019 and data relating to financial AHS. Using validated methods, we rescaled assessment scores on analogous scales to enable comparison and binned them in quartiles. We then used a distributed lag model (DLM) in a Bayesian ordinal regression framework to assess the effects of AHS on capacity development over time. Strong evidence exists for associations between financial assistance and select capacities on a variety of lagged time intervals. Financial assistance had positive effects on zoonotic disease capacities in the year it was disbursed, and positive effects on legislation, laboratory, workforce, and risk communication capacities one year after disbursal. Financial assistance had negative effects on laboratory and emergency response capacities two years after it was disbursed. Financial assistance did not have measurable effects on coordination, antimicrobial resistance (AMR), food safety, biosafety, surveillance, or response preparedness capacities over the timeframe considered. Financial AHS is associated with positive effects for several core health security capacities. However, for the majority of capacities, levels of funding were not significantly associated with capacity level, though we cannot fully exclude endogeneity. Future work should continue to investigate these relationships in different contexts and examine other factors that may contribute to capacity development.
Highlights
Recent years have witnessed substantial increases in the amounts of donor financial assistance for health (DAH)
The global health community has demonstrated an interest in understanding broad trends in DAH,[1,2] as well as how DAH has been allocated amongst competing priorities.[3,4,5,6,7,8]
To better understand the impacts of assistance for health security (AHS) on capacities for preventing, detecting, and responding to public health emergencies, this paper presents an analysis of the effects of AHS and changes in health security capacity over time
Summary
Recent years have witnessed substantial increases in the amounts of donor financial assistance for health (DAH). The revised International Health Regulations (IHR) are a legally binding instrument that represent a guiding framework for global health security. These Regulations require Member States to develop and maintain capacities for public health emergency surveillance and response.[9] With the adoption of the IHR 2005, and the launch of the 2014 Global Health Security Agenda, countries, philanthropies, and other development partners began to explicitly provide assistance for health security (AHS) that was designed to increase national-level health security capacities. Much of this work has been focused on capacity building projects, especially after the 2014 Ebola epidemic exposed the potential consequences of serious deficiencies in public health and healthcare infrastructure.[10]
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