Mortality changes after grants from the Global Fund to Fight AIDS, tuberculosis and malaria: an econometric analysis from 1995 to 2010

BMC Public Health

Research Article

Isabel Yan¹  Eline Korenromp²  Eran Bendavid³ 

[1] Department of Economics and Finance, City University of Hong Kong, Tat Chee Avenue, Kowloon, Hong Kong;Department of Public Health, Erasmus MC, University Medical Center, Postbus 2040 3000, Rotterdam, CA, The Netherlands;Avenir Health, Geneva, Switzerland;Division of General Medical Disciplines, Stanford University Stanford, 94305, Stanford, CA, USA;Center for Health Policy and the Center for Primary Care and Outcomes Research, Stanford University, 94305, Stanford, CA, USA;

关键词: Global Fund;    Mortality;    Outcomes evaluation;   

DOI  :  10.1186/s12889-015-2305-1

 received in 2015-03-20, accepted in 2015-09-21,  发布年份 2015

来源: Springer

【 摘 要 】

BackgroundSince its founding in 2002, the Global Fund to Fight AIDS, Tuberculosis, and Malaria (Global Fund) has become the dominant multilateral health financier in low- and middle-income countries. The health impact of the Global Fund remains unknown because existing evaluations measure intermediate outcomes or do not account for preexisting and counterfactual trends.MethodsWe conducted an econometric analysis of data from all countries eligible to receive Global Fund grants from 1995 to 2010, prior to and during the Global Fund’s activities. We analyzed three outcomes: all-cause adult (15–59 years), all-cause under-five, and malaria-specific under-five mortality. Our main exposure was a continuous longitudinal measure of Global Fund disbursements per capita. We used panel fixed effect regressions, and analyzed mortality trends controlling for health spending, health worker density (a measure of health system capacity), gross domestic product, urbanization, and country fixed-effects.Results and discussionWe find that following Global Fund disbursements, adult mortality rate declined by 1.4 % per year faster with every $10 per capita increase in disbursements (p = 0.005). Similarly, malaria-specific under-five mortality declined by 6.9 % per year faster (p = 0.033) with every $10 high per capita Global Fund disbursements. However, we find no association between Global Fund support and all-cause under-five mortality. These findings were consistent after subanalyses by baseline HIV prevalence, adjusting for effects of concurrent health aid from other donors, and varying time lags between funding and mortality changes.ConclusionsGrants from the Global Fund are closely related to accelerated reductions in all-cause adult mortality and malaria-specific under-five mortality. However, up to 2010 the Global Fund has not measurably contributed to reducing all-cause under-five mortality.

【 授权许可】

CC BY   
© Yan et al. 2015