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Skip to 0 minutes and 11 seconds MATTHEW REEVE: Hello. I’m Matthew Reeve from the Nossal Institute for Global Health. And I’m here to walk you through a website that’s very useful for analysing health systems. Before we start, if you’re watching this on a mobile phone, I’d encourage you to either wait until you can see it on a larger screen or to access the PDFs with screenshots of the website, available in the link below. The Institute for Health Metrics and Evaluation, IHME, based in Seattle, is known for its work in measuring the global burden of disease. Another activity they’ve been tracking is the flow of development assistance funding to health, or DAH initiatives, and spending on health globally.

Skip to 0 minutes and 57 seconds So let’s look at some visualisations on their website to learn more about the powerful players in global health as expressed through who has the money. Let’s start by looking at which channel of development assistance for health is the largest. So in this visualisation, you can see the sources of health funding on the left going to particular health issues on the right, here. And then here in the middle, we have the different organisations and countries which are the channels for this funding, which gives them particular power in global health. You can see that in 2017, NGOs and foundations were by far the largest channel for development money for health, channelling $11.1 billion US.

Skip to 1 minute and 38 seconds Many people would be surprised to know that it’s not UN agencies or individual countries that are the largest channels. So which channel has grown the most? Now we’ll click on the Trends tab at the top to see how this has changed over time. And on the right side of the screen, this graph represents the percent change in funding between 2010 and 2017. And you can see that the Bill and Melinda Gates Foundation has increased the most, at 81% between 2010 and 2017. And during the same time, the World Bank IBRD funding has decreased by 61%.

Skip to 2 minutes and 16 seconds Now if you check the Absolute Change box down at the bottom, representing how the change in dollars spent, you can see by how much– the Bill and Melinda Gates Foundation, increase of 989 million, and the Global Fund, an increase of 907 million have increased their share in financing global health, compared to the decrease by the World Bank IBRD of 1.2 billion in that time frame. So how has the UN agency’s share changed? It’s probably easiest to see this if you click on Separated in the drop-down menu on the bottom left-hand corner of the graph. Look at the left-hand graph.

Skip to 2 minutes and 54 seconds The UN agencies and WHO have increased slightly, but have remained largely unchanged since 2010, with WHO actually showing a small decrease. Now it’s worth reflecting on what this means, so which agencies have greater influence on policy and whether the biggest funders of global health are those who support whole-of-system strengthening or whether they are the agencies that traditionally have supported particular vertical programmes. Now let’s look at the Sources of Development Assistance for Health, which is the largest. Make sure that you’ve checked the Source button at the bottom of the screen.

Skip to 3 minutes and 29 seconds And then if you switch between graphing as either percentage or stacked in the bottom left-hand corner, you can see that the United States provides about $12 billion US of development assistance, which is around 33% of all global development assistance for health. Now, these visualisations have been about development assistance for health, but if we move across to this spending visualisation, we can see where all money spent on health goes. And if we look at low income countries, which we are now, you’ll see that development assistance in green is still a sizable chunk of health spending. But the government spending in blue and out-of-pocket spending in orange are both substantial proportions with spending too.

Skip to 4 minutes and 11 seconds Out-of-pocket spending is when someone pays directly for services. It could be private or public services. Now, if we look at low/middle income countries, which is a much larger group of countries than low income countries, you’ll see development assistance is a very small part of health spending. But note the rising proportion of spending on private prepayment programmes, such as health insurance schemes in purple, and the large and increasing proportion of spending that’s out-of-pocket in orange. What do you think these trends might tell us about the power dynamics in the health system in these low and low/middle income countries– not just among funders and health care providers, but also consumers? I’m leaving this graph on the screen.

Skip to 4 minutes and 50 seconds Please pause the video and have a look at the graph. And comment below on what you think the impact of these changing trends might be.

Skip to 5 minutes and 1 second This IHME website is a great resource for understanding and comparing health systems and their outcomes. So I encourage you to visit the site through the link below and become familiar with it.

Exploring global health financing using data visualisation tools

This video is best viewed on a large screen. If you are unable to see the detail of graphs, please download and view the pdf screenshots.

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Health Systems Strengthening

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