New Delhi: Two studies published in medical journal The Lancet reveal the health financing crisis facing developing countries as a result of stagnating international aid and low domestic investment. Between 2000 and 2009, international aid increased at around 11% each year. However, since 2010, annual growth has been a meagre 1.2%, hampering projects in developing countries to maintain and improve health. Funding for diseases like malaria, tuberculosis and HIV/AIDS, which attracted maximum funding in the 2000s, has been hit the most.

Global health funding increased substantially after 2000, just as the United Nations established the Millennium Development Goals (MDGs). The majority of funding over the past 16 years, adding up to almost $255 billion (around 60% of all international aid) has been focused on MDG-related health areas. While development aid for malaria and tuberculosis increased by more than 25% from 2000-09, the funding declined substantially after 2010.

As the three are communicable diseases, effects could be devastating. Already, developing countries in Asia and Africa, including India, are facing stock-outs of drugs and testing kits for HIV/AIDS. Since 2010, aid for maternal health and newborn and child health has slowed less funding than for other health focus areas.

The study predicts that future international aid could vary widely, with an average estimate of about $64 billion in 2040. But there remains large uncertainty about just how much funding will increase, with yearly growth rates ranging from -0.72% to 5.96%

The studies conclude that decreased funding for health could leave millions of people without access to even the most basic health services.

The two studies, led by Joseph Dieleman from the Institute for Health Metrics and Evaluation (IHME), Seattle, USA, will be presented this week at the World Bank Group Universal Health Coverage Annual Financing Forum at Washington DC.

Dieleman said that the results show that poor countries will not be able to spend adequately on health for the next 25 years. “Historically, some of these financing gaps have been filled by international aid. But, funding growth has stalled in recent years and future projections suggest that global health funding may not be sufficient to bridge the gap," he said.

He added, “These changes in the growth and focus of international aid could have a serious impact on over 15 million people taking antiretroviral therapy in developing countries and on health services in some low-income countries, particularly in sub-Saharan Africa where HIV/AIDS, tuberculosis, and malaria remain among the top threats to health."

Antiretroviral therapy is the treatment of HIV/AIDS, provided at low or no cost by governments in developing nations.

Taking targets produced by Innovative International Financing for Health Systems and Chatham House as the basis, projections in the study show that many low-income countries are not expected to reach globally agreed financing targets by 2040. The targets state that every government should commit to spend at least 5% of GDP on health and move progressively towards this target.

Also, every government should ensure health expenditures per person of at least $86 per year, the minimum needed to ensure universal health coverage of priority services for everyone.

The research estimates that by 2040, average health spending per person will range from $164 in low-income countries to $9019 in high-income countries, remaining lowest in sub-Saharan Africa in countries like Somalia ($34), and highest in the US ($16592).

Only one low-income country (Rwanda) and around a third (36 of 98) of middle-income countries will meet the international target of governmental health spending reaching 5% of gross domestic product (GDP) by 2040.

Moreover, even after adjusting for purchasing power, the spending gap between low- and high-income countries is not expected to narrow, with low-income countries spending almost the same per person on health compared to high-income countries in 2040 as they did nearly 50 years ago.

“For low- and middle-income countries to reach international spending targets and close the gap, domestic and international health funding will need to increase beyond historical growth rates," said Dieleman. “In low-income countries, on average $0.71 of international aid is provided for every $1 of domestic government funding, making it a critical resource."

“The era of major growth in international aid for health has, at least temporarily, seemed to have ended. This may lead to substantial shifts in how global health is financed. Much will depend on how donors target their scarce resources and how governments fill gaps," says Dieleman.