Sources and Focus of Health Development Assistance, 1990–2014

IMPORTANCE: The governments of high-income countries and private organizations provide billions of dollars to developing countries for health. This type of development assistance can have a critical role in ensuring that life-saving health interventions reach populations in need. OBJECTIVES: To identify the amount of development assistance that countries and organizations provided for health and to determine the health areas that received these funds. EVIDENCE REVIEW: Budget, revenue, and expenditure data on the primary agencies and organizations (n = 38) that provided resources to developing countries (n = 146-183, depending on the year) for health from 1990 through 2014 were collected. For each channel (the international agency or organization that directed the resources toward the implementing institution or government), the source and recipient of the development assistance were determined and redundant accounting of the same dollar, which occurs when channels transfer funds among each other, was removed. This research derived the flow of resources from source to intermediary channel to recipient. Development assistance for health (DAH) was divided into 11 mutually exclusive health focus areas, such that every dollar of development assistance was assigned only 1 health focus area. FINDINGS: Since 1990, 458. 0 billion of development assistance has been provided to maintain or improve health in developing countries. The largest source of funding was the US government, which provided 143. 1 billion between 1990 and 2014, including 12. 4 billion in 2014. Of resources that originated with the US government, 70. 6% were provided through US government agencies, and 41. 0% were allocated for human immunodeficiency virus (HIV) /AIDS. The second largest source of development assistance for health was private philanthropic donors, including the Bill and Melinda Gates Foundation and other private foundations, which provided 69. 9 billion between 1990 and 2014, including 6. 2 billion in 2014. These resources were provided primarily through private foundations and nongovernmental organizations and were allocated for a diverse set of health focus areas. Since 1990, 28. 0% of all DAH was allocated for maternal health and newborn and child health; 23. 2% for HIV/AIDS, 4. 3% for malaria, 2. 8% for tuberculosis, and 1. 5% for noncommunicable diseases. Between 2000 and 2010, DAH increased 11. 3% annually. However, since 2010, total DAH has not increased as substantially. CONCLUSIONS AND RELEVANCE: Funding for health in developing countries has increased substantially since 1990, with a focus on HIV/AIDS, maternal health, and newborn and child health. Funding from the US government has played a substantial role in this expansion. Funding for noncommunicable diseases has been limited. Understanding how funding patterns have changed across time and the priorities of sources of international funding across distinct channels, recipients, and health focus areas may help identify where funding gaps persist and where cost-effective interventions could save lives.