The money distributed by WHO, either through its regular budget or extra budgetary funds, does not match the relative burdens of different diseases globally. Ministers of health, donor agencies, philanthropists, and international agencies must all address this when they meet in Bamako, Mali, on November 16-19*, for The Global Ministerial Forum on Research for Health. These are the conclusions of an Article published in this week's Bamako special edition of The Lancet, written by Dr David Stuckler, University of Cambridge*, UK.
The researchers compared the WHO biennial budgetary allocations with the burden of diseases from 1994-95 to 2008-09. The data was then matched up with disease burden in two regions — Western Pacific and Africa — that are at differing stages of epidemiological transition. Further assessments were made based on the source of funding and the mechanism for deciding how funds were spent.
They found that WHO budget allocations were heavily and disproportionately skewed toward infectious diseases. In 2006-07, WHO allocated 87% of its total budget to infectious diseases, 12% to non-communicable diseases, and less than 1% to injuries and violence. A similar distribution of funding was recorded in Africa, where around 75% of mortality is from infectious disease, and in Western Pacific, where around 75% of mortality is from non-communicable disease. In both regions, injuries received only 1% of total resources. The skew towards infectious disease was substantially greater from WHO's extra-budgetary fund, which is allocated by donors and has risen substantially in recent years, than for the WHO regular budget, which is decided on by member states through democratic mechanisms and has been held at zero nominal growth.
The authors conclude: "Decision makers at Bamako should consider the implications of the present misalignment of global health priorities and disease burden for health research worldwide. Funds allocated by external donors substantially differ from those allocated by WHO member states. Bamako provides an opportunity to consider how this disparity might be addressed."
In an accompanying Comment, Dr Alan Lopez, School of Population Health, University of Queensland, Brisbane, Australia, says: "Discussion should recognise that the gross imbalance of donor funds towards the control of communicable disease is not costless for the organisation: effort and resources devoted to communicable disease, however justified, will inevitably distract attention away from the massive, largely preventable health loss from injuries and non-communicable diseases. The very substantial disease burden from injuries and non-communicable diseases is also very much WHO's concern, and responsibility. Although Stuckler and colleagues show that donor funding to control these conditions is increasing, it is doing so only very slowly and remains grossly disproportionate to need. The challenge for WHO is to make the case more convincingly to donors."
A linked Editorial discusses the failures to date of health systems and policy research, and concludes: "A different approach for improving health research and translating policy into action is urgently needed. Past and current efforts have failed. Perhaps we need a G8 for research (R8)—that could include the US NIH, UK's Wellcome Trust, French CNRS/INSERM, Indian Council of Medical Research, Chinese Academy of Sciences, Brazil's Fiocruz, the South African MRC, and a comparable institute from the Middle-East? This group should meet before the main G8 meeting each year and issue its own research manifesto for political leaders to take account of and respond to."
See also Health Policy.
*Dr David Stuckler was at the University of Cambridge when completing this work, but is now at the University of Oxford, UK. Please credit the work to The University of Cambridge.
T) +44(0)7726422212
E) david.stuckler@chch.ox.ac.uk
Professor Martin McKee, European Centre on Health of Societies in Transition, London School of Hygiene & Tropical Medicine, UK
T) +44(0) 20 7927 2229
E) martin.mckee@lshtm.ac.uk
Dr Alan Lopez, School of Population Health, University of Queensland, Brisbane, Australia
T) +61 400 115 231
E) a.lopez@sph.uq.edu.au
Alternative contact for David Stuckler: Tom Kirk, Office of Communications, University of
Cambridge, UK
T) +44(0)1223766205,
E) tdk25@admin.cam.ac.uk
Lancet Press Office
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E) pressoffice@lancet.com
For full Article, Comment, Editorial, and Health Policy see: http://press.thelancet.com/WHOfunding.pdf
Notes to editors: **The Global Forum for Health Research meets at Bamako, Mali, between November 16-19.
Journal
The Lancet