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Global health funding at the World Health Organisation (WHO) is skewed towards infectious diseases and does not reflect the actual health needs of recipient countries, say researchers in The Lancet this month (1 November).

The United Kingdom-based team compared the allocations for infectious diseases, chronic non-communicable diseases and injury with their burden — deaths and number of productive years of life lost due to a disease — in each budget cycle of the WHO from 1994–95 to 2008–09.

They looked at whether there was a difference between the regular WHO budget, to which all member states contribute and which is decided by democratic consensus, and extra-budgetary funds, which are voluntary and most often come from developed countries.

They found consistent evidence that funding is skewed towards infectious diseases. In 2006–07, for example, infectious diseases, non-communicable diseases and injury received 87, 12 and one per cent of funds respectively. This skew was even more extreme in the extra-budgetary funds.

The pattern was the same in both Africa and the Western Pacific, despite differing patterns of disease burden — Africa has a high infectious disease burden and relatively low non-communicable diseases, while the opposite is true in the Western Pacific.

Lead author David Stuckler, research fellow in the department of sociology at the University of Oxford, told SciDev.Net that it was possible the gap was even wider in other global health-related organisations such as the World Bank and the Gates Foundation.

He added that many institutions follow the WHO's lead in global health. "WHO has the opportunity to step out as a bold leader for setting global health priorities. Yet it, in part, is transferring this decision-making role away from its member states to private donors. Our study echoes the point that we need democracy in global public health."

He said that infectious diseases are prioritised for a variety of reasons, which include the North's perception of a threat from Southern infectious diseases; perceived economic cost; and a holdover from the WHO's inception when infectious diseases were prevalent.

"Our analysis suggests that donors are giving money out of geopolitical or economic interests, rather than based on the actual health needs of recipients," he said. Martin McKee, co-author of the study, from the London School of Hygiene & Tropical Medicine, added that "the 2008 Bamako ministerial forum offers a rare opportunity to reassess research priorities".

Addressing the forum's delegates, Stuckler said: "Consider whether the way money is being allocated is in the best interests of those receiving the funds. Try to establish systems for oversight and for empowering health ministries to set their own priorities through democracy, [and] not only through private philanthropy."

Link to full paper in The Lancet*

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The Lancet 9, 649, 1,563 (2008)

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