Abstract
Recent developments have transformed the role and characteristics of middle-income countries (MICs). Many stakeholders now question the appropriate role of MICs in the system of development assistance for health (DAH), and key funders have already recast their approach to these countries. The pressing question is whether MICs should be recipients, funders, both or neither. The answer has deep implications for individual countries and their citizens, and for the DAH system as a whole. We clarify the fundamental issues involved and emphasise a special feature of many MICs: mid-level gross national income per capita (GNIpc) combined with substantial health needs and large inequalities. We discuss the trade-off between concerns for capacity and need, and illustrate a capacity-based approach to setting the level of a GNIpc eligibility threshold. We also discuss how needs-based exceptions and incentive-preserving instruments can complement such a threshold. Against this background, we outline options for the future roles of MICs in various circumstances. We conclude that major players in the DAH system have reason to reconsider the criteria for allocating DAH among countries and the norms for which countries should contribute and how much.
Highlights
Recent changes Recent developments have transformed the role and characteristics of middleincome countries (MICs), as defined by the World Bank
The MIC category comprises 105 countries, 70% of the world’s population, over 30% of the global GDP, over 75% of the world’s poor, and almost 70% of the disease burden in the world (Sumner, 2012) [based on data from the World Bank and the Institute for Health Metrics and Evaluation (IHME)]. These transitions have reinforced a special feature of MICs collectively and of many MICs individually: mid-level gross national income per capita (GNIpc) combined with substantial poverty and unmet health needs and large inequalities in income and health
Underlying the specific question about MICs is a fundamental question for the development assistance for health (DAH) system: what should be the criteria for identifying recipient and funding countries? Linked to both questions is the issue of country classification and income classification in particular
Summary
Recent changes Recent developments have transformed the role and characteristics of middleincome countries (MICs), as defined by the World Bank. The MIC category comprises 105 countries (fiscal year 2015), 70% of the world’s population, over 30% of the global GDP, over 75% of the world’s poor, and almost 70% of the disease burden in the world (Sumner, 2012) [based on data from the World Bank and the Institute for Health Metrics and Evaluation (IHME)]. These transitions have reinforced a special feature of MICs collectively and of many MICs individually: mid-level gross national income per capita (GNIpc) combined with substantial poverty and unmet health needs and large inequalities in income and health. Underlying the specific question about MICs is a fundamental question for the DAH system: what should be the criteria for identifying recipient and funding countries? Linked to both questions is the issue of country classification and income classification in particular
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