title: Where did all the aid go? An in-depth analysis of increased health aid flows over the past 10 years.
abstract: OBJECTIVE
  To examine how health aid is spent and channelled, including the distribution of resources across countries and between subsectors. Our aim was to complement the many qualitative critiques of health aid with a quantitative review and to provide insights on the level of development assistance available to recipient countries to address their health and health development needs.
  
  
  METHODS
  We carried out a quantitative analysis of data from the Aggregate Aid Statistics and Creditor Reporting System databases of the Organisation for Economic Co-operation and Development, which are the most reliable sources of data on official development assistance (ODA) for health from all traditional bilateral and multilateral sources and from partnerships such as the Global Fund to Fight AIDS, Tuberculosis and Malaria.
  
  
  RESULTS
  The analysis shows that while health ODA is rising and capturing a larger share of total ODA, there are significant imbalances in the allocation of health aid which run counter to internationally recognized principles of "effective aid". Countries with comparable levels of poverty and health need receive remarkably different levels of aid. Funding for Millennium Development Goal 6 (combat HIV/AIDS, malaria and other diseases) accounts for much of the recent increase in health ODA, while many other health priorities remain insufficiently funded. Aid is highly fragmented at country level, which entails high transaction costs, divergence from national policies and lack of coherence between development partners.
  
  
  CONCLUSIONS
  Although political momentum towards aid effectiveness is increasing at global level, some very real aid management challenges remain at country level. Continued monitoring is therefore necessary, and we recommend that a review of the type presented here be repeated every 3 years.
authors.affiliation: Health System Governance and Service Delivery, World Health Organization, avenue Appia 20, 1211 Geneva 27, Switzerland. pivap@who.int
authors.forename: Paolo
authors.initials: P
authors.lastname: Piva
authors.forename: Rebecca
authors.initials: R
authors.lastname: Dodd
mesh_terms: D016208:Databases, Factual; D003695:Delivery of Health Care / Q000191:economics*; D003906:Developing Countries; D005381:Financing, Organized / Q000639:trends*; D014943:Global Health; D007390:International Agencies; D007391:International Cooperation
references.citation: Science. 2006 Jan 13;311(5758):162-7
references.pmid: 16410496
references.citation: Health Policy Plan. 2008 Mar;23(2):95-100
references.pmid: 18156161
references.citation: Soc Sci Med. 1997 Aug;45(3):449-63
references.pmid: 9232739
references.citation: J Int Dev. 1995 May-Jun;7(3):329-47
references.pmid: 12290761
references.citation: Trop Med Int Health. 2000 Jul;5(7):467-71
references.pmid: 10964268
references.citation: Soc Sci Med. 2000 Sep;51(6):979-89
references.pmid: 10972440
references.citation: Health Aff (Millwood). 2007 Jul-Aug;26(4):935-48
references.pmid: 17630435
references.citation: Health Policy Plan. 2006 Nov;21(6):411-20
references.pmid: 16984894