gtbr2023

International donor funding for tuberculosis: an analysis of donor reports to the Organisation for Economic Co-operation and Development

In 2002, the World Health Organization (WHO) started annual monitoring of funding for tuberculosis (TB) prevention, diagnostic and treatment services, based on data reported by national TB programmes (NTPs) in annual rounds of global TB data collection. Findings have been published in global TB reports and peer-reviewed publications (1–3). However, not all international donor funding for TB is captured in the data reported to WHO. Therefore, each year, WHO complements its analysis of data reported by NTPs with an assessment of international donor funding for TB, based on donor reports to the Organisation for Economic Co-operation and Development (OECD).

The OECD’s creditor reporting system (CRS) (4) is the most comprehensive source of information about international donor funding. The CRS Aid Activity database makes it possible to analyse where aid goes, what purposes it serves and what policies it aims to support, on a comparable basis for all members of the OECD Development Assistance Committee (DAC). Data are for developing countries or areas eligible to receive official development assistance (ODA); they are collected for individual projects and programmes, with a focus on financial data (4).

As of 2023, funding data (both commitments and disbursements) were provided by 37 multilateral donor organizations, 30 members of the OECD’s DAC (29 individual countries and the European Union) and a further 20 countries beyond the DAC that report to the OECD. Disbursement data include both direct transfers to countries and the provision of goods and services (e.g. in-kind transfers or technical assistance).

Data on gross total official disbursements for TB (code 12263: Tuberculosis control) received by non-OECD countries during 2013–2021 were analysed (as of July 2023, the latest year for which data have been reported is 2021). The CRS does not capture funding for TB that flows from one OECD member to an institution or government within the OECD. In addition, government contributions that are channelled through multilateral organizations - such as the Global Fund to Fight AIDS, Tuberculosis and Malaria (the Global Fund) - are attributed to the multilateral organization and not to the government of origin.

Fig. 1 shows trends in international donor funding between 2013 and 2021 for the six WHO regions and for all low- and middle-income countries (LMICs). The total for LMICs from all sources in 2021 was US$ 973 million.

Fig. 1  International donor funding for TB by source based on donor reports to the OECD, 2013–2021

Global Fund: Global Fund to Fight AIDS, Tuberculosis and Malaria; OECD: Organisation for Economic Co-operation and Development; WHO: World Health Organization.
a As per the 2023 World Bank classification. The subtotals for the six WHO regions do not sum to the total for all low and middle-income countries combined. This is because funding recorded in regional (rather than country-specific) categories used by the OECD cannot be matched to a specific WHO region, and the recipient country for country-level funding is sometimes not specified.

 

From 2013 to 2021, the Global Fund was consistently the largest provider of international donor funding in LMICs, with its share averaging 65% in this period. In 2021, the total was US$ 613 million (63% of the global total of US$ 973 million).

Annual disbursements of bilateral funding from the United States of America (US) between 2013 and 2021 that were recorded in the OECD database (Fig. 1) ranged from US$ 202 million to US$ 283 million per year; in 2021, the total amount disbursed was US$ 237 million. These amounts are lower than official US congressional allocations for TB (5, 6), which have grown from US$ 232 million in 2013 to US$ 328 million in 2021, US$ 381 million in 2022 and US$ 406 million in 2023 (Fig. 2).

Fig. 2 Official US congressional allocations of funding for TB, 2013–2023


 

When bilateral funding from individual countries reported to the OECD is combined with estimates of individual country contributions for TB that are channelled through the Global Fund, the US government is by far the largest source of international donor funding for TB (Fig. 3). In the period 2013–2021, it provided 48% of the total amount of donor funding for TB from entities that report to the OECD; in the most recent year for which data are available (2021), the share was 51%. The next largest individual country contributors in the period 2013–2021 were (in order of their contribution) the United Kingdom of Great Britain and Northern Ireland (8.6%), France (6.8%), Germany (5.5%), Japan (4.6%) and Canada (4.5%).

Fig. 3 Distribution of international donor funding for TB when Global Fund contributions are allocated to individual countries and other reporting entities,a 2013–2021

Funding totals for each entity are the sum of a) funding for TB reported to the OECD, excluding that channelled via the Global Fund and b) an estimate of the funding provided for TB via the Global Fund.b
International donor funding (in US\$ millions) for TB prevention, diagnosis and treatment from individual countries
Global Fund: Global Fund to Fight AIDS, Tuberculosis and Malaria; OECD: Organisation for Economic Co-operation and Development; United Kingdom: United Kingdom of Great Britain and Northern Ireland; WHO: World Health Organization.
a Other reporting entities includes any countries beyond the 10 that are labelled that provide international donor funding for TB, and multilateral agencies (excluding the Global Fund).
b The estimate is based on the assumption that the share of a country or other entity’s contribution to TB funding provided by the Global Fund is the same as its share of total contributions to the Global Fund. For example, if a country provided 5% of the total contributions to the Global Fund, it was assumed to provide 5% of the TB funding attributed to the Global Fund in the OECD database.

 

Fig. 4 shows that international funding for TB (US$ 973 million in 2021) is about a third of that for malaria (US$ 2.5 billion in 2021) and about 13% of that for HIV (US$ 7.6 billion in 2021). Overall, TB funding constitutes 2.7% of total ODA funding for health and population programmes (US$ 36 billion in 2021).

Fig. 4 International donor funding for Health and Population programmes, TB, HIV and malaria, 2013–2021

HIV: human immunodeficiency virus; STD: sexually transmitted disease.

 

References

  1. Floyd K, Fitzpatrick C, Pantoja A, Raviglione M. Domestic and donor financing for tuberculosis care and control in low-income and middle-income countries: an analysis of trends, 2002–11, and requirements to meet 2015 targets. Lancet Glob Health. 2013;1(2):e105–15. doi: https://doi.org/10.1016/S2214-109X(13)70032-9.

  2. Floyd K, Pantoja A, Dye C. Financing tuberculosis control: the role of a global financial monitoring system. Bull World Health Organ. 2007;85(5):334–40. doi: https://doi.org/10.2471/blt.06.034942.

  3. Su Y, Baena IG, Harle AC, Crosby SW, Micah AE, Siroka A et al. Tracking total spending on tuberculosis by source and function in 135 low-income and middle-income countries, 2000–17: a financial modelling study. Lancet Infect Dis. 2020;20(8):929–42. doi: https://doi.org/10.1016/S1473-3099(20)30124-9.

  4. OECD.Stat [website]. Paris: Organisation for Economic Co-operation and Development; 2022 (https://stats.oecd.org).

  5. The US government and global tuberculosis efforts. San Francisco: Kaiser Family Foundation; 2023 (https://www.kff.org/global-health-policy/fact-sheet/the-u-s-government-and-global-tuberculosis-efforts/?msclkid=2a614d82caf311ecb251baaa5c42217b).

  6. US foreign assistance dashboard [website]. Washington, DC: Office of Management and Budget, Agency Congressional Budget Justifications, Congressional Appropriation Bills; 2023 (https://www.foreignassistance.gov/).