Foreign Health Aid Research Articles

Analysis of maternal and child health spillover effects in PEPFAR countries

ObjectivesThis study examined whether the US President’s Emergency Plan for AIDS Relief (PEPFAR) funding had effects beyond HIV, specifically on several measures of maternal and child health in low-income and...

Examination of the Effectiveness of United States Foreign Aid on Human Development in United Nations Least Developed Countries: An Empirical Study

The aim of this article is to examine the effectiveness of United States (U.S.) foreign aid on human development in United Nations (U.N.) Least Developed Countries (LDCs). Research Design and Methods: Research of peer reviewed studies on effectiveness of U.S. foreign aid support to U.N. LDCs were conducted using ProQuest and Google Scholar databases. A select literature review of keywords is offered to elucidate understanding of current perspectives. The study approach is based on empirical evidence. This study employs a set of multivariate linear regression models to examine the effects of U.S. foreign aid on health, education, and social services on the Human Development Index (HDI) in LDCs from 2000 to 2020. Findings: The findings show that U.S. foreign aid for health sectors significantly impacted HDI in LDCs for the time period under review. Evidence Limitation/Implications: An important limitation is highlighted by the need for increased research on other variables identified per the HDI. Discussion: The results of this study suggest that U.S. foreign aid has had a positive effect on the achievement of human development goals in the health sectors of LDCs. Past research has linked improved human development outcomes with increased economic development which contributes to the sustainable development of a society. The significance of these findings warrants further research regarding the contribution of U.S. foreign aid to positive human development outcomes and economic growth. Contribution and Value: This article extends contribution and value to LDCs growth and sustainability by providing empirical evidence of the effect of U.S. foreign aid on the U.N. LDCs.

Estimating Chinese foreign health aid: an analysis of AidData's Global Chinese Official Finance dataset

BackgroundChinese global health aid has expanded tremendously since the 2000s. Unlike many donors, China has no official aid reporting obligations, nor does it voluntarily disclose detailed aid information. Therefore, several third parties have attempted to estimate China's health aid footprint. However, current estimates use varied definitions of health aid, geographic regions, and time spans. These distinct methodological approaches make comparisons of Chinese aid to other aid donors difficult. Our study builds on previous tracking efforts and improves on them by creating a standardised estimate using commonly accepted definitions of aid and frameworks for categorising health projects. MethodsWe categorised AidData's Chinese Official Finance Dataset health-related projects according to health aid frameworks from the Organization for Economic Co-operation and Development (OECD) and the Institute for Health Metrics and Evaluation (IHME). Only projects that fitted the definition of official development assistance were included. We analysed data by both total project count and financial value to assess priority health-aid focus areas for China. We also provide an updated estimate for projects with missing financial values in AidData's database by applying the median cost of similar projects to projects with missing financial values, allowing for comparison with other donors. FindingsBetween 2000 and 2014, China funded 620 health-related aid projects, which made up more than 20% of its total aid project portfolio. Most of these projects were located in Africa. According to the OECD framework, the priority focus areas of these 620 projects were: basic health care, such as medical teams, drugs, and medicine (n=244, 36%); malaria control (118, 19%); medical services, such as specialty equipment, infrastructure and services (108, 17%); and basic health infrastructure (78, 13%). According to the IHME framework, health-systems strengthening accounted for 70% (n=434) of total projects, primarily due to China's contributions to human resources for health, infrastructure, and equipment. The only other significant allocation under the IHME framework was malaria (n=118, 19%). When we estimate missing financial values, we noted that China was the fourth largest health aid donor to African countries from 2008–2014, after the USA, UK, and Canada. InterpretationThese findings enable a better understanding of Chinese health aid in the absence of transparent aid reporting. Such understanding could lead to better coordination, collaboration, and resource allocation for both fellow donors and recipient countries. FundingHuang Fellows Program, Duke University Science & Society (PK).

Noncommunicable disease outcomes and the effects of vertical and horizontal health aid

Foreign health aid forms a substantial portion of health spending in many low- and middle-income countries (LMICs). It can be either vertical (funds earmarked for specific diseases) or horizontal (funds used for broad health sector strengthening). Historically, most health aid has been disbursed vertically toward key infectious diseases, with minimal allocations to noncommunicable diseases (NCDs). High NCD burden in LMICs underscores a need for increased assistance toward NCD objectives, but evidence on the outcomes of health aid for NCDs is sparse. We obtained annual data on cause-specific deaths and disability-adjusted life years (DALYs) for four leading NCDs across 116 countries, 2000–2016, and evaluated the relationship between these indicators and vertical and horizontal health aid using country fixed-effects models with 1-to-5-year lagged effects. After adjusting for fixed and time-variant country heterogeneity, vertical assistance for NCDs was significantly associated with subsequent reductions in NCD morbidity and mortality, particularly for persons under age 70 and for cardiovascular and chronic respiratory diseases. An additional dollar in per-capita NCD vertical assistance corresponded to reductions in the average annual NCD burden of 7,459 DALYs/281 deaths after one year, 7,728 DALYs/319 deaths after two years, and 8,957 DALYs/346 deaths after three years. The findings suggest that vertical assistance for NCD programs may be an appropriate mechanism for addressing short-term NCD needs in LMICs, where it may help to fill health sector gaps in NCD care, but longer-term evaluation is needed for assessing the role of horizontal assistance.

The Lazarus Effect and the Labour Market: Evidence from At-Scale Antiretroviral Therapy in Zambia

Abstract Between 2000 and 2015, access to life-saving antiretroviral therapy (ART) in sub-Saharan Africa increased from virtually 0% to approximately 40% coverage. Despite the promise of ART to improve health, a variety of supply- and demand-side factors suggest at-scale ART may not improve employment outcomes. To measure the causal effect of ART on employment outcomes, I use triple-difference regression analysis, exploiting spatial, temporal and demographic variation in intensity of ART exposure during scale-up in Zambia. My results suggest that local ART introduction increased employment of likely HIV+ adults by eight percentage points, or approximately 15% relative to the sample mean. Cash employment and employment for no pay—the first and second largest employment categories in Zambia, respectively—each comprised roughly one-half of the employment gains. Temporal and spatial heterogeneity analyses support a causal interpretation of the results. These findings appear to be the first at-scale quasi-experimental evidence suggesting that ART, the single largest item in many countries’ foreign health aid budgets, can improve employment outcomes among the targeted.

China’s foreign health aid: history, challenges, perspectives, and policy recommendations

Health aid is integral to both China’s foreign aid and foreign policies. Over the last six decades, China’s health aid has grown in both diversity and scale. As a result of ever fiercer jostling between great powers and the further globalization of healthcare in the twenty-first century, China now faces challenges that relate to increasing both the scope and influence of health aid, bringing it under unified management, ensuring a steady supply of medical workers, and efficiently spreading proven national experience. As a responsible great power, China has therefore made a series of new commitments and proposals regarding foreign health aid in the new era and establishing the long-awaited national international cooperation agency dedicated to the overarching policy-making and management of foreign aid. Nevertheless, further developing national strategies, legal frameworks, decision-making and management mechanisms, and a holistic model for aid while deepening engagement with international cooperation are also essential for China’s future health aid reform.

Foreign Aid and HIV/AIDS in Latin America and the Caribbean: Should We Adjust the Degree of Response?

This paper estimates the effects of foreign aid on Human Immunodeficiency Virus (HIV) prevalence in a sample of 27 Latin American and Caribbean countries during 1995–2013 and advocates for stronger sentinel surveillance to monitor the stability of the epidemic in the region. Surges in global HIV funding have improved access to health care and antiretroviral therapy, leading to gains in life expectancy. HIV is a prime cause of death and disability in resource-poor settings. It declines with more global funding for health, yet its pathway is random. The net impact of foreign aid on health is unknown due to poor surveillance. HIV’s unsystematic nature requires better metrics arising from global aid data to calibrate the degree of response in the region. A dynamic panel-data model with robust standard errors was used to determine if changes in HIV were associated with changes in foreign aid for health in the sample but the positive association was not statistically significant. Better data from local epidemics is needed to reveal population- and group-specific trends.

Have geopolitics influenced decisions on American health foreign assistance efforts during the Obama presidency?

BackgroundThis study sought to characterize the possible relationship between US geopolitical priorities and annual decisions on health foreign assistance among recipient nations between 2009 and 2016.MethodsData on total planned United States (US) foreign aid and health aid were collected for the 194 member nations of the World Health Organization (WHO) from publicly available databases. Trends in per-capita spending were examined between 2009 and 2016 across the six regions of the WHO (Africa, Americas, Eastern Mediterranean, Europe, Southeast Asia, and the Western Pacific). Data on US national security threats were obtained from the Council on Foreign Relations’ annual Preventive Priorities Survey. Multivariable regression models were fitted specifying planned health aid as the dependent variable and threat level of a recipient aid nation as the primary independent variable.ResultsAcross the aggregate 80 planned recipient countries of US health aid over the duration of the study period, cumulative planned per-capita spending was stable (US$ 0.65 in both 2009 and 2016). The number of annual planned recipients of this aid declined from 74 in 2009 to 56 in 2016 (24.3% decline), with planned allocations decreasing in the Americas, Eastern Mediterranean, and Europe; corresponding increases were observed in Africa, Southeast Asia, and the Western Pacific. Regression analyses demonstrated a dose-response, whereby higher levels of threat were associated with larger declines in planned spending (critical threat nations: b = -3.81; 95% confidence interval (CI) -5.84 to -1.78, P ≤ 0.001) and one-year lagged (critical threat nations: b = -3.91; 95% CI, -5.94 to -1.88, P ≤ 0.001) analyses.ConclusionsHigher threat levels are associated with less health aid. This is a novel finding, as prior studies have demonstrated a strong association between national security considerations and decisions on development aid.

The relationship between burden of childhood disease and foreign aid for child health

BackgroundWe sought to examine the relationship between child specific health aid (CHA) and burden of disease. Based on existing evidence, we hypothesized that foreign aid for child health would not be proportional to burden of disease.MethodsIn order to examine CHA and burden of disease, we obtained estimates of these parameters from established sources. Estimates of disability adjusted life years (DALYs) in children (0–5 years) were obtained from the World Health Organization for 2000 and 2012. The 10 most burdensome disease categories in each continent, excluding high-income countries, were identified for study. Descriptions of all foreign aid commitments between 1996 and 2009 were obtained from AidData, and an algorithm to designate the target diseases of the commitments was constructed. Data were examined in scatterplots for trends.ResultsThe most burdensome childhood diseases varied by continent. In all continents, newborn diseases, vaccine-preventable diseases (lower respiratory diseases, measles, meningitis, tetanus, and pertussis), and diarrheal diseases ranked within the four most burdensome diseases. Infectious diseases such as malaria, tuberculosis, and HIV were also among the ten most burdensome diseases in sub-Saharan Africa, and non-communicable diseases were associated with much of the burden in the other continents. CHA grew from $7.4 billion in 1996 to $17.7 billion in 2009 for our study diseases. Diarrheal diseases and malnutrition received the most CHA as well as the most CHA per DALY. CHA directed at HIV increased dramatically over our study period, from $227,000 in 1996 to $3.4 billion in 2008. Little aid was directed at injuries such as drowning, car accidents, and fires, as well as complex medical diseases such as leukemia and endocrine disorders.ConclusionCHA has grown significantly over the last two decades. There is no clear relationship between CHA and burden of disease. This report provides a description of foreign aid for child health, and hopes to inform policy and decision-making regarding foreign aid.

Trump's Abortion-Promoting Aid Policy.

On the fourth day of his presidency, Donald Trump reinstated and greatly expanded the "Mexico City policy," which imposes antiabortion restrictions on U.S. foreign health aid. In general, the policy has prohibited U.S. funding of any family-planning groups that use even non-U.S. funds to perform abortions; prohibited aid recipients from lobbying (again, even with non-U.S. money) for liberalization of abortion laws; prohibited nongovernment organizations from creating educational materials on abortion as a family-planning method; and prohibited health workers from referring patients for legal abortions in any cases other than rape, incest, or to save the life of the mother. The policy's prohibition on giving aid to any organization that performs abortions is aimed at limiting alleged indirect funding of abortions. The argument is that if U.S. money is used to fund nonabortion programs of an abortion-providing NGO, then the NGO can simply shift the money thus saved into its abortion budget. Outside the context of abortion, we do not reason this way. And the policy's remaining three prohibitions are deeply troubling.

Taking the health aid debate to the subnational level: the impact and allocation of foreign health aid in Malawi

ObjectiveCross-national studies provide inconclusive results as to the effectiveness of foreign health aid. We highlight a novel application of using subnational data to evaluate aid impacts, using Malawi as a...

International Ecumenical Community Development Aid in Bad Hands: The Case of the Bu Health Centre Project of the Presbyterian Church in Cameroon

The Bu Health Centre Project was initiated by the Presbyterian Church inCameroon (PCC) and the Bu people and adequately funded by ‘Bread forthe World’ (BW), a Christian aid organisation. It was a community development initiative aimed at improving the health of the Bu people. Butthe foreign ecumenical health aid, as evidenced by the final phase andattainments of the project, did not result in community development due toimplementation constraints. This paper, based on primary and secondarydata, provides evidence of the misuse of foreign ecumenical communitydevelopment aid, showing that recipient churches engulfed by corrupt practices are more likely to improperly administer such funds. The BuHealth Centre Project in northwest Cameroon is used as a case study forexamining the issue. The paper begins with a conceptualization of international ecumenical aid and community development given theircentrality to the study. This is followed by a theoretical framework embedded in the current aid debate whose insight can shed light on whyforeign aid fails to deliver. The paper goes on to discuss PCC-BW partnership in service provision in Cameroon, and pays attention to PCC’spresence in Bu. It further lays bare the genesis and execution of the BuHealth Centre Project, and rounds up with an analytical discourse forunderstanding why the project failed. The study sustains the argument thatthe failure to transmit the international ecumenical aid set aside for the BuHealth Centre Project into beneficial outcomes rests on the attitude of thedonor agency, the recipient institution, and the traditional and civilauthorities of the recipient community.Keywords: Ecumenical Aid, Community Development, Recipient Institution, Health Care, Misappropriation, Presbyterian Church in Cameroon, Bread for the World

Perceptions of foreign health aid in East Africa: an exploratory baseline study.

There is insufficient literature on the perceptions of aid recipients with respect to foreign health aid administration and impact. This study sought to identify perceptions of foreign health aid among individuals, health care workers (HCWs), and policymakers in three East African countries: Kenya, Uganda, and Ethiopia. Each country receives substantial foreign aid and shares regional proximity. A qualitative exploratory study design was adopted and 81 questionnaires were administered to individuals, HCWs and policymakers. Questionnaires ascertained perceptions of foreign aid, health aid and the USA. Responses were compared between groups and across countries. Perceptions of how much foreign aid a community receives varied between individuals ('a little'), HCWs ('some') and policymakers ('a lot'). Respondents were positive towards the USA irrespective of the level of aid they perceived came from the USA. Opinions regarding the impact of aid varied by country and by profession. Aid priorities were similar among all countries and participants, with health care, education and economic development among the primary sectors reported. More research is needed on perceptions of aid recipients. The findings of this pilot study highlight the need for inclusion of these stakeholders in order to better inform decisions regarding foreign aid.

Relation between disease-specific foreign aid for child health and burden of disease in sub-Saharan African countries

Abstract Background Foreign aid for health has increased substantially in the past two decades. However, there is limited information on the relation between the distribution of foreign aid for health and the actual burden of disease in different diseases and age groups, particularly children. We examined the association between disease-specific foreign aid for children (FACH) and burden of disease. Methods Burden of disease data including estimates of disability adjusted life years (DALYs) were derived from the WHO Global Health Estimates resource for 2000–11. Children 0–5 years of age in sub-Saharan African countries were examined and the number of DALYs lost for the top 15 diseases calculated. Data for foreign aid were derived from the AidData dataset, which includes descriptions of all foreign aid donations. We constructed an instrument that searched the text of each description for words indicative of a certain disease, such as malaria or bed-net, and designated child or infant in the age category. Findings Overall, the amount of FACH increased substantially during the period 1996–2009, from US$3·5 billion in 1996 to US$13·5 billion in 2009. The relation between the burden of disease and the amount of disease-specific FACH was mixed. For example, diarrhoeal diseases were responsible for 19% of DALYs lost in 2009, and were targeted with 21% of FACH. By contrast, the amount of FACH targeted towards HIV in 2009 (5·5%) was much more than the that of lost DALYs caused by HIV (23%). Pneumonia, however, was responsible for the most DALYs lost in 2009 (29%) yet received only 0·6% of all FACH. Interpretation Our findings suggest that the relation between the distribution of foreign aid for child health and burden of disease in sub-Saharan African countries is mixed. Further work is needed to analyse present distribution patterns of foreign aid for child health and to advise future distribution Funding None.

Can Foreign Health Assistance Reduce the Medical Brain Drain?

In this article, we analyse the impact of foreign health aid on the emigration rates of physicians. The analysis is based on a dataset of physician emigration rates from 50 source countries between 1998 and 2004. First, we investigate the direct impact of health assistance using the generalised method of moments estimation, and we highlight the significant negative effect of foreign health assistance on the medical brain drain. Second, we show that this effect results more from technical assistance than from financial assistance. Finally, the robustness of our analysis is verified to confirm the validity of the results.

Global Health Governance: Analysing China, India and Japan as Global Health Aid Donors

AbstractDevelopment assistance is a significant mechanism by which major countries exercise influence in the global health arena. Of the major Asian powers, Japan has long provided significant funding, while China and India have primarily been recipients but are beginning to increase their funding roles. This article examines the amounts, channels, modes, disease allocations and the geographic focuses of their foreign health aid, and delineates the institutional structures that govern the formulation and implementation of foreign health aid policy in each of these countries, to explore what influence China, India, and Japan have and may develop in the global health arena. The article looks in particular at two focal lenses, sovereignty and institutional diversity, to understand what if anything is different from existing approaches to global health governance and what might be expected from these three key Asian nations vis‐à‐vis global health.Policy Implications Japan’s global health leadership transcends its bilateral initiatives. The critical question that emerges now is whether Japan can sustain its will and capacity without clear policy direction from the current government amid domestic turmoil. What is to be done by Japan, and who will do it? China and India have not engaged extensively with the global processes as donors. Yet, as recipients they have been open to a wide range of types of actors and relatively relaxed about sovereignty concerns, possibly providing a basis for a similar direction in development assistance for health (DAH) as their programs mature. The domestic institutions responsible for external development assistance for health in both China and India would need to be substantially reformed and strengthened for these countries to have the capacity to play leading roles in global health governance in the future. China and India increasingly have the capacity to invest greater resources in their own public health systems, which would redress some of the existing imbalances in allocations of global health finance. Such domestic investment in domestic health care delivery would enhance India and China’s capacity to assume leadership roles and contribute towards innovations within global health and global health governance and augment their status as responsible and responsive global health stakeholders.

Canadian foreign aid for global health: Human security opportunity lost

(2009). Canadian foreign aid for global health: Human security opportunity lost. Canadian Foreign Policy Journal: Vol. 15, No. 3, pp. 60-84.

Intelligence, Foreign Health Aid, and Bioterror Defence

Arguments for the provision of foreign aid to help relieve the blight of developing countries have traditionally centred on obligations of benevolence and a duty to help those less fortunate.1 However, the War on Terror has resulted in a significant shift in how foreign aid is perceived. International prosperity and stability are now recognized as key elements in a fight to ameliorate the conditions that give rise to terrorism. Public support for foreign aid in general, normally unpopular, has increased since 11 September 2001 due to greater public understanding of its role in combating terrorism.2 In particular, the need to address attitudes of foreign civilians toward the United States has become more widely recognized as a key component of efforts to reduce the ferment of the terrorist mindset. These strategies have assumed particular importance in light of the non-traditional nature of the threat posed by contemporary terrorism: a threat posed not by states or armies, but by individuals and groups who blend into, garner both the implicit and explicit support of, and are recruited from general civilian populations.

Editorial

This issue is the third in an ongoing series examining the political, social and economic implications of war in the contemporary world. Previous issues on this theme (Theoria 109, April 2006, and 110, August 2006) touched on debates about ‘old’ and ‘new’wars, militant American neoconservatism and the war on terror, the ramifications of humanitarian intervention and conscientious objection, and prospects for global justice and peace. The implications of current U.S. foreign policy continue to loom large in this issue, but the focus falls in addition on the personal and moral effects of war and its consequences for the individual: the moral claims behind the Bush Doctrine, and its effects on domestic issues and personal life, the question of targeted killings of individual terrorists, the continued relevance and utility of Clausewitz’s theory of war, and the use of foreign health aid as a deterrent to bioterrorism.

Essai d'évaluation de l'aide internationale dans le domaine de la santé au Tchad

AbstractForeign aid is the favourite source of funding for health care in Chad, representing more than eighty percent of the annual health care expenditures. The purpose of this study is to provide through an analytical approach that is both strategic and interventionist, information for the users of foreign health aid in Chad. The study shows that priorities of this aid, conceived as aid for direct intervention, have a specific purpose: the promotion of the modern health care system. The strategies of the intervention are based on a vertical or selective approach. Institution building, primary health care, the health of mother and child, and the fight against AIDS consume more than 80% of the aid budget. Two problems are related to the process of the distribution of aid in Chad. The first concerns the political willingness to target resources in specific problems of health care. The second concerns the health system's inability to organize and to extend health services for the population in the countrysi...