Introduction to the topic. Economic power being exercised by HICs through [[DAH]] and other means; through institutions, bank, initiatives, and development bank, funding regional efforts such as [[ASEAN]], Asia Pacific. Source of funds: governments, multilateral agencies (WB, NGOs, foundations, [[global health partnerships]], recipient government [[resource mobilisation]]) Roles: source of fund, channels of assistance, implementing partners ![[CleanShot 2024-06-08 at [email protected]]] Complexity of financing: other than altruism, donor countries advance their own interest, economic or foreign policy (such as [[neoliberalism]]) Alexander Marley in the forum explained about ways to improve mosquito nets. A succint explanation coupled with recommendations: Shift from vertical to horizontal development programs, shift from donor-led to community-led distribution, shift from top-down to bottom-up health promotion. On the other hand, the arrangement through bilateral with HICs may serve their purpose, such as commitment to purchase some amount of goods, such as medicines or clinical equipment, from companies located within donor countries. The result of this narrow, closed market may cost the recipient countries rather than benefiting them if they were engaged on the open market. Trends: from disease-specific programs with interest from HICs, to a common middle-ground such as MDGs and SDGs, for example mental health was not a priority, then NCD, climate change, surveillance, primary health care, etc. Highlights: DAH in 2019-2020 is the greatest of all, highlighting a large [[resource mobilisation]]. Even the establishment of [[Pandemic Fund]] is there. Funding plateued or declined for a number of health areas between 2015 and 2019. However, there were challenges such as halting of routine care to shift for emergency response, resulting in setbacks of SDGs. Even funding for vertical disease-specific programs may fluctuate and jeopardize the sustainability of the program. For example, as recorded by IHME in 2020, total DAH experienced a decrease from 2017. On the other hand, public-private organisation such as [[Global Fund to Fight AIDS, Tuberculosis, and Malaria (GFATM)]] contributed $1 bio. IHME also recorded $7 bio as unallocable funding, suggesting problems in monitoring financial assistance. Lesson from COVID-19 as we have seen too with astrazenecca vaccine, even though Oxford has Oxford Innovation Unit, an office that are ready to give license, signed exclusive licensing with AZ and later on sell the vaccine at a profit-making price. The lack of transparency in source & flows of funds to R&D in the whole value chain of vaccine also added a layer of complexity, with an estimate 21% of private sector contribution, the expectation of ROI is inevitable. ## DAH In 2019, G20 meeting discussed about DAH and the role of G20 in shaping the DAH and global health financing. At that time, it was apparent that there issues with the current state of DAH. One of the most apparent was [[DAH is primarily, although not entirely, driven by the interests of high-income countries]]. For example, in relation to power being exercised through economic power, Prof. [[Johanna Hanefeld]] from the last Seminar elaborated how a country see a matter will determine how they saw an issue, for example tuberculosis. For the HICs perspective, they might think about helping the recipient countries so if they come to the HICs, they will not infect its citizens. However, from the perspective of recipient countries it may not seem so. They care about sanitation, providing adequate housing, urbanisation, and health system strengthening in general, not communicable disease control or pandemic potential pathogen. G20, which comprised approximately 80% of the world economies, had a major role to play in global health financing. As we saw in 2023, G20 Indonesia launched [[Pandemic Fund]] to provide sustainable funding for pandemic prevention, preparedness, and response. However, from the required budget calculated, it was still far from enough. [[DAH]] - Flow of funds are plateuing, except COVID. - Targets of DAH mainly disease-focused instead of HSS. Partly because HSS is poorly defined and thus the donor-recipient countries relationship are difficult to evaluate, esp. that DAH involves tax power money where the donor countries reside and need to be held accountable there. - This, in part, explains why NCDs are underfunded; unlike infectious diseases they are not perceived as an immediate risk to national security - Consequently, the monitoring of effectiveness is complicated: weak accountability, inconsistency in data collection, and reporting methods within and across countries - Phantom aid in the form of administrative cost or debt relief. To move forward with DAH, needs to: - Make donor-recipient countries accountable to each other with specifically defined terms for horizontal programs rather than disease-specific programs. Countries can use SDGs as the north start to guide the process of assistance and define areas of work and collaboration. - Donor countries must start to see the problem through the recipient countries' perspective rather than exercising the second face of power (agenda-setting) that might undermine the issue they want to assist - Moving forward, concept of DAH must be able to answer three concerns/questions posed Dieleman in 2019. First, DAH must be able to support equitable health gains for people who needs it wherever they are. In this case, eligibibility based on national income must be left behind and include criteria such as burden of disease, and in-country socioeconomic conditions, environmental conditions to take into account. - In pandemic context, DAH can look and evaluate their role on financing [[global public goods for health (GPGH)]], particularly R&D cost that became a dispute in COVID-19 pandemic, and global sytem to prevent and respond to large-scale outbreaks. -