Donor financing of global mental health, 1995–2015: An assessment of trends, channels, and alignment with the disease burden

Abstract

A recent report by the Institute for Health Metrics and Evaluation (IHME) highlights that mental health receives little attention despite being a major cause of disease burden. This paper extends previous assessments of development assistance for mental health (DAMH) in two significant ways; first by contrasting DAMH against that for other disease categories, and second by benchmarking allocated development assistance against the core disease burden metric (disability-adjusted life year) as estimated by the Global Burden of Disease Study.

Methods

In order to track DAH, IHME collates information from audited financial records, project-level data, and budget information from the primary global health channels. The diverse set of data were standardized and put into a single inflation-adjusted currency (2015 US dollars) and each dollar disbursed was assigned up to one health focus area from 1990 through 2015. We tied these health financing estimates to disease burden estimates (DALYs) produced by the Global Burden of Disease 2015 Study to calculated a standardized measure across health focus areas – development assistance for health (in US dollars) per DALY.

Findings

DAMH increased from US $18 million in 1995 to US $132 million in 2015, which equates to 0.4% of total DAH in 2015. Over 1990 to 2015, private philanthropy was the most significant source (US $435 million, 30% of DAMH), while the United States government provided US $270 million of total DAMH. South and Southeast Asia received the largest proportion of funding for mental health in 2013 (34%). DAMH available per DALY in 2013 ranged from US $0.27 in East Asia and the Pacific to US $1.18 in the Middle East and North Africa. HIV/AIDS received the largest ratio of funds to burden – approximately US $150 per DALY in 2013. Mental and substance use disorders and its broader category of non-communicable disease received less than US $1 of DAH per DALY.

Interpretation

Combining estimates of disease burden and development assistance for health provides a valuable perspective on DAH resource allocation. The findings from this research point to several patterns of unproportioned distribution of DAH, none more apparent than the low levels of international investment in non-communicable diseases, and in particular, mental health. However, burden of disease estimates are only one input by which DAH should be determined.