Health impact of external funding for HIV, tuberculosis and malaria: systematic review.
BACKGROUND
Since 2002, development assistance for health has substantially increased, especially investments for HIV, tuberculosis (TB) and malaria control. We undertook a systematic review to assess and synthesize the existing evidence in the scientific literature on the health impacts of these investments.


RESULTS
We systematically searched databases for peer-reviewed and grey literature, using tailored search strategies. We screened studies for study design and relevance, using predefined inclusion criteria, and selected those that enabled us to link health outcomes or impact to increased external funding. For all included studies, we recorded dataset and study characteristics, health outcomes and impacts. We analysed the data using a causal-chain framework to develop a narrative summary of the published evidence. Thirteen articles, representing 11 individual studies set in Africa and Asia reporting impacts on HIV, tuberculosis and malaria, met the inclusion criteria. Only two of these studies documented the entire causal-chain spanning from funding to programme scale-up, to outputs, outcomes and impacts. Nonetheless, overall we find a positive correlation between consecutive steps in the causal chain, suggesting that external funds for HIV, tuberculosis and malaria programmes contributed to improved health outcomes and impact.


CONCLUSIONS
Despite the large number of supported programmes worldwide and despite an abundance of published studies on HIV, TB and malaria control, we identified very few eligible studies that adequately demonstrated the full process by which external funding has been translated to health impact. Most of these studies did not move beyond demonstrating statistical association, as opposed to contribution or causation. We thus recommend that funding organizations and researchers increase the emphasis on ensuring data capture along the causal pathway to demonstrate effect and contribution of external financing. The findings of these comprehensive and rigorously conducted impact evaluations should also be made publicly accessible.
Gephyra IHC, Laing's Nekstraat 39-1, 1092 GT, Amsterdam, The Netherlands, ETC Crystal, PO Box 64, 3830 AB, Leusden, The Netherlands, Imperial College Business School, Imperial College London, London, UK, Department of Public Health, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China, The Global Fund to Fight Against AIDS, Tuberculosis and Malaria, Geneva, Switzerland and Department of Primary and Community Care, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands thyra.dejongh@gephyra.nl.
Thyra E
TE
de Jongh
Gephyra IHC, Laing's Nekstraat 39-1, 1092 GT, Amsterdam, The Netherlands, ETC Crystal, PO Box 64, 3830 AB, Leusden, The Netherlands, Imperial College Business School, Imperial College London, London, UK, Department of Public Health, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China, The Global Fund to Fight Against AIDS, Tuberculosis and Malaria, Geneva, Switzerland and Department of Primary and Community Care, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
Joanne H
JH
Harnmeijer
Gephyra IHC, Laing's Nekstraat 39-1, 1092 GT, Amsterdam, The Netherlands, ETC Crystal, PO Box 64, 3830 AB, Leusden, The Netherlands, Imperial College Business School, Imperial College London, London, UK, Department of Public Health, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China, The Global Fund to Fight Against AIDS, Tuberculosis and Malaria, Geneva, Switzerland and Department of Primary and Community Care, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
Rifat
R
Atun
Gephyra IHC, Laing's Nekstraat 39-1, 1092 GT, Amsterdam, The Netherlands, ETC Crystal, PO Box 64, 3830 AB, Leusden, The Netherlands, Imperial College Business School, Imperial College London, London, UK, Department of Public Health, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China, The Global Fund to Fight Against AIDS, Tuberculosis and Malaria, Geneva, Switzerland and Department of Primary and Community Care, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
Eline L
EL
Korenromp
Gephyra IHC, Laing's Nekstraat 39-1, 1092 GT, Amsterdam, The Netherlands, ETC Crystal, PO Box 64, 3830 AB, Leusden, The Netherlands, Imperial College Business School, Imperial College London, London, UK, Department of Public Health, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China, The Global Fund to Fight Against AIDS, Tuberculosis and Malaria, Geneva, Switzerland and Department of Primary and Community Care, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
Jinkou
J
Zhao
Gephyra IHC, Laing's Nekstraat 39-1, 1092 GT, Amsterdam, The Netherlands, ETC Crystal, PO Box 64, 3830 AB, Leusden, The Netherlands, Imperial College Business School, Imperial College London, London, UK, Department of Public Health, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China, The Global Fund to Fight Against AIDS, Tuberculosis and Malaria, Geneva, Switzerland and Department of Primary and Community Care, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
John
J
Puvimanasinghe
Gephyra IHC, Laing's Nekstraat 39-1, 1092 GT, Amsterdam, The Netherlands, ETC Crystal, PO Box 64, 3830 AB, Leusden, The Netherlands, Imperial College Business School, Imperial College London, London, UK, Department of Public Health, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China, The Global Fund to Fight Against AIDS, Tuberculosis and Malaria, Geneva, Switzerland and Department of Primary and Community Care, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
Rob
R
Baltussen
D000349:Africa; D001208:Asia; D003906:Developing Countries; D005260:Female; D005378:Financial Support; D015658:HIV Infections / Q000191:economics* / Q000401:mortality / Q000628:therapy; D006801:Humans; D008288:Malaria / Q000191:economics* / Q000401:mortality / Q000517:prevention & control; D017063:Outcome Assessment, Health Care; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000628:therapy; D014376:Tuberculosis / Q000191:economics* / Q000628:therapy
Africa; Asia; Health financing; developing countries; donors; health outcomes; impact