Professor Allyala Krishna Nandakumar
Last week, Professor Allyala Krishna Nandakumar presented a lecture titled, “Global Health Spending: Learning to Do More with Less. ” The lecture was one of a series known as “Tuesday Talks,” a lecture series held by the Heller School for Social Policy and Management. The lecture room was fully attended by faculty, staff, students, and alumni who came to hear Nandakumar explain the problems with our global health spending, namely, that we need to spend the funds we have more efficiently.
The world spends about 5 trillion on health a year. While this enormous amount has only increased over the past decade, the rate of morbidity and mortality has not decreased at the rate one would expect if such funds and technology are available. For instance, since 1990, annual child mortality decreased by 30%. Yet still, 8.8 million children died in 2008. This unfortunate disparity, according to a World Bank assessment, is the result of poorly managed projects and an inefficient allocation of funds. Moreover, many of these projects share similar characteristics: negligible monitoring and evaluation, inadequate supervision, lack of baseline data for which to set realistic targets, and insufficient political or institutional analysis to name a few.
To complicate matters, the majority of donor funds go to Third World countries where corrupt governments misuse them. Since 2008, however, the majority of donations have been channeled through NGO’s or non-governmental organizations in order to offset the rampant corruption.
Another complication is that low-come countries are often dependent on donor funds from high-income countries. This dependency is very dangerous for a state since donor funds are volatile and therefore unsustainable. This is especially disconcerting because many low-income states substitute donor funding as the sole means for government health spending. This dependency is also harmful because states receiving funds are not allowed to decide how to allocate funds: much of global health spending is “disease specific” in that donors typically donate for a specific cause such as HIV AIDS or malaria, and thus states who receive funds may not even be able to use them.
Another issue with global health spending is the unequal distribution of donors. Low-income countries, which compose 85% of the world’s population, only contribute 14.3% share of global health funds. Meanwhile, high-income countries, which compose 15% of the world’s population, contribute 82% of the global health spending. For instance, Ethiopia spends less than $10 per person on health; the US, nearly $7,300. This places a burden on high-income countries such as the United States, to sustain the health programs of other countries. Surprisingly, while the United States is the leader in global health funding, the second largest source of funding comes not from a country but from the Bill and Melinda Gates Foundation. Where are countries like Britain, France, and Germany? This interesting fact shows that other high-income states aren’t pulling enough weight.
Evidently, there are many problems with our global health spending. It goes without saying that millions of people shouldn’t have to die every year from diseases that could have been cured or treated but weren’t due to rampant corruption and a host of problems in our global health spending. We have the funds, we just need to allocate them more efficiently. To remedy these problems, we can employ numerous measures: increase accountability and transparency of governments to combat corruption, ensure that funds reach beneficiaries directly to avoid waste, empower individuals with health vouchers, and reform the health care system. Only then can we prevent needless death and disease. For more information on global health spending, visit the World Health Organization online.
Jacob Bockelmann graduated from Brandeis in 2009 with a Bachelor of Arts in Politics and Economics, with a minor in business. After taking a class on globalization taught by Professor Thomas Friedman, Jacob gained a new perspective on global issues. Upon his graduation, he decided to spend his first several months out of college traveling and volunteering abroad. He is currently traveling throughout Southeast Asia with his final destination being New Dehli. He will be spending over four months volunteering in rural areas, allowing him opportunities to explore, in addition to developing his professional skills in an entirely new context and community. The following excerpts and photographs are taken from Jacob’s personal blog, 
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