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Where have all the donors gone?

“Researchers and policymakers in developing countries are bringing attention to the gap between donor funding for noncommunicable diseases and the disease prevention and care requirements of poor populations […] There is a current, substantial, unmet need to address NCDs in poor countries, preferably with approaches that simultaneously reduce other sources of ill health. These voices have not yet been heard by the international donor community, whose inertia in responding to NCD problems and continued emphasis on communicable disease deters from developing countries adapting their health and broader governmental systems to a new set of health risks.”

“Where Have All the Donors Gone? Scarce Donor Funding for Noncommunicable Diseases” was published as a Center for Global Development Working Paper in November 2010. The authors of the report are Rachel A. Nugent (University of Washington) and Andrea B. Feigl (Harvard School of Public Health).

The report includes sections on:

  • Trends in NCD prevalence and risks in developing countries
  • Role of donor funding for NCDs
  • Literature review, scope, and methods
  • Trends in donor funding for NCDs
  • Conclusions and the road ahead
  • Appendices: NCD donor funding by type of donor, literature on global health donor funding, detailed description of CGD NCD donor funding tracking methods


Health conditions in developing countries are becoming more like those in developed countries, with non-communicable diseases (NCDs) predominating and infectious diseases declining. The increased awareness of changing health needs, however, has not translated into significant shifts in resources or policy-level attention from international donors or governments in affected countries. Driven by changes in lifestyle related to nutrition, physical activity, and smoking, the surging burden of NCDs in poor countries portends painful choices, particularly for countries with weak health systems that are struggling to manage persistent infectious disease burdens and to protect the poor from excessive out-of-pocket expenses.

Global development assistance for health (DAH) was estimated at $21.8 billion in 2007 (Ravishankar et al., 2009). A recent assessment shows that official development assistance for health reached $26.4 billion in 2008, surpassing all prior years (Kates etal., 2010). No specific mention is made of DAH for NCDs in developing countries in either study. This paper aims to fill that gap. We conducted an analysis of donor spending on NCDs in developing countries from 2001 to 2008 that reveals that less than 3 percent ($503 million out of $22 billion) of overall DAH was dedicated to NCDs in 2007. The amount of donor assistance for health rose to $686 million in 2008. In terms of the burden of disease, donors provided about $0.78/DALY attributable to NCDsin developing countries in 2007, compared to $23.9/DALY attributable to HIV, TB, and malaria. If donors provided just half the support to avoid NCD DALYs that they provide to the three infectious diseases, it would amount to almost $4 billion in DAH for NCDs.

The picture of donor involvement in NCDs is not entirely bleak. Donor funding to developing countries for NCDs grew by 618 percent between 2001 and 2008, with the largest increase coming from private, non-profit donors, and evidence of accelerating interest from bilateral donors. Multilateral organizations remain the largest category of funders. Nonetheless, additional donor funding is needed to support developing-country efforts to incorporate NCDs into their existing health care programs through such mechanisms as hypertension and cancer screening and prevention programs, and proven policy solutions such as tobacco taxation and salt reduction.