Issue: Global Health

Context

In 2019, the WHO set the ambitious “Triple Billion Targets” for healthier populations (one billion more people enjoying better health and well-being), UHC (one billion people benefiting from universal health coverage), and health emergencies (one billion people better protected from health emergencies) by 2025, in support of the SDGs. Before the COVID-19 pandemic, the world was off track to meet the triple billion targets, and the health-related SDGs – progress has been further stifled by the pandemic. Despite the challenges of the pandemic, the global health community has made historic achievements. In the past 5 years, the wild poliovirus reached its lowest levels, 58 countries adopted policies eliminating trans-fat, tobacco use is decreasing in 150 countries, 15 countries have eliminated mother-to-child transmission of HIV and/or syphilis, 52 million people have been vaccinated against yellow fever, and a malaria vaccine expected to save 40,000-80,000 annually was developed. Additionally, the global health sphere has seen the emergence of new actors, agencies, foundations, and new forms of investment.

To get back on track toward achieving the “triple billion targets” and health SDGs, the global community must mobilize to address the consequences of the COVID-19 pandemic and ongoing pandemic response, climate change, and emerging and shifting disease burdens. Achieving development goals is increasingly challenging as domestic resourcing is constrained, ODA budgets are shrinking, and pressure increases on multilateralism and international solidarity in an increasingly complex global health arena.

Funding Trends

How is ODA to global health evolving?

The global health sector receives one of the largest shares of development assistance among social sectors (13% to 17%). In 2021, funding for global health stood at US$34.9 billion – a 32% increase compared to US$26.5 billion in 2020. The large increase is attributed to increased global spending on health in response to the COVID-19 pandemic.

Supply of multilateral ODA to global health from DAC donors peaked in 2021, but growth is not expected to continue at this pace. Core contributions to health multilaterals hit an all-time high of US$13.3 billion in 2021 because of exceptional funding in response to the COVID-19 pandemic. Earmarked funding through multilaterals also reached an all-time high of US$6.5 billion in 2021, partially driven by US$2.4 billion of vaccine dose donations. However, most global health ODA flows bilaterally – on average over the past 5 years, only 33% of funding was channeled as core contributions to multilaterals.

Multilateral funding

The majority of DAC donors’ core multilateral contributions go to the Global Fund and Gavi – this accounts for more than 70% of all core multilateral funding between 2017 and 2021. Growth in volume in 2020 and 2021 is partially inflated by COVID-19 pandemic-related funding channeled through the Global Fund and Gavi as part of ACT-A. Agencies also receive earmarked funding through multilaterals rather than core funding.

Top Donors & Sectors

Who are the top donors to global health?

In 2021, the G7 countries were the top donors to global health, contributing 82% of all global health funding. The largest donor was by far the US, followed by Germany, the UK, Japan, and France.

US contributions to global health (US$14.6 billion) were unusually high due to exceptional COVID-19 pandemic-related commitments. Germany’s ODA to global health (US$4.7 billion) increased by 40% in absolute terms, between 2020 and 2021 due to Germany’s engagement in the multilateral response to the COVID-19 pandemic. Despite substantial cuts to its ODA budget, the UK was still on aggregate the third largest donor to global health (US$2.4 billion).

Canada and the US lead the DAC countries in prioritizing global health in relative terms, with 31% (Canada) and 30% (the US) of total ODA in support of global health. Canada and the US are followed by Australia (23%), Iceland (22%), and Korea (22%) which are among the top five donors to prioritize global health in relative terms. Despite falling among the top five absolute contributors to global health, Germany, France, and Japan contribute less than 15% of their total bilateral ODA to global health.

Which global health sub-sectors receive the largest funding?

32% of donor countries' bilateral global health spending in 2021 was focused on COVID-19 control. STD control, including HIV/AIDS, is the second largest sub-sector of global health spending, accounting for 22.7% of DAC donor countries’ total bilateral ODA for health in 2021. Spending on reproductive health care has notably decreased in absolute terms since 2017, and relative terms since 2019.