Financial Assistance for Health Security: Effects of International Financial Assistance on Capacities for Preventing, Detecting, and Responding to Public Health Emergencies

Abstract

Background: Health security funding is intended to improve the ability to prevent, detect, and respond 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 on levels of capacity. Methods: We collected publicly available health security assessment scores published between 2010 and 2019 and data relating to financial assistance for health security. 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 in a Bayesian ordinal regression framework to assess the effects of assistance for health security on capacity development over time. Findings: 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, food safety, biosafety, surveillance, preparedness, or risk communication capacities over the timeframe considered. Interpretation: Financial assistance for health security 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. Funding Statement: The Open Philanthropy Project provided financial support to the Georgetown University Center for Global Health Science & Security that supported this work. Declaration of Interests: The authors declare no competing interests.