HIV Financing Bias in India !

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Health Financing in Brazil, Russia and India: What Role Does the International

Community Play?

Devi Sridhar1,* and J. Gómez2

1All Souls College, Oxford, UK and 2Rutgers University, New Jersey, USA.

*Corresponding author. All Souls College, High St, Oxford OX1 4AL, UK. Tel: +44

1865 281407. Email: devi.sridhar@...

Health Policy and Planning Advance Access published online on April 16, 2010.

doi:10.1093/heapol/czq016

(Abstract)

In this paper we examine whether Brazil, Russia and India have similar financing

patterns to those observed globally.

We assess how national health allocations compare with epidemiological estimates

for burden of disease. We identify the major causes of burden of disease in each

country, as well as the contribution HIV/AIDS, tuberculosis and malaria make to

the total burden of disease estimates. We then use budgetary allocation

information to assess the alignment of funding with burden of disease data.

We focus on central government allocations through the Ministry of Health or its

equivalent. We found that of the three cases examined, Brazil and India showed

the most bias when it came to financing HIV/AIDS over other diseases. And this

occurred despite evidence indicating that HIV/AIDS (among all three countries)

was not the highest burden of disease when measured in terms of age-standardized

DALY rates.

We put forth several factors building on Reich's (2002) framework on `reshaping

the state from above, from within and from below' to help explain this bias in

favour of HIV/AIDS in Brazil and India, but not in Russia: `above' influences

include the availability of external funding, the impact of the media coupled

with recognition and attention from philanthropic institutions, the government's

close relationship with UNAIDS (UN Joint Programme on HIV/AIDS), WHO (World

Health Organization) and other UN bodies; `within' influences include political

and bureaucratic incentives to devote resources to certain issues and

relationships between ministries; and `below' influences include civil society

activism and relationships with government.

Two additional factors explaining our findings cross-cutting all three levels

are the strength of the private sector in health, specifically the

pharmaceutical industry, and the influence of transnational advocacy movements

emanating from the USA and Western Europe for particular diseases.

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Ps/ Could somebody send me a copy of this article? Thanks.

Joe