Moving beyond donor disbursements as a measure of investment in health; the need to track expenditures

In recent years, due to the surge in donor funding for priority health services and a growing demand for accountability, there has been a burgeoning of global donor disbursement databases (e.g. Global Fund, OECD, UN). While this is needed and portrays successful advocacy efforts, to measure actual investment in health, it is critical for these databases go further to track expenditures or perhaps to link to ongoing expenditure tracking initiatives, like National Health Accounts (NHA). Intended as a routine policy tool, NHA monitors funds from their sources to their end uses. It does so in a comprehensive manner and attempts to verify each estimate by consulting with recipients of donor funds (e.g. the Ministry of Health (MoH), nongovernmental organizations) to determine if disbursed amounts were actually spent in the given year and for what purposes. Findings from a multi-country study of NHA initiatives (including Ethiopia, Kenya, Malawi, Rwanda, Vietnam) show that donor disbursements are not necessarily spent as intended. For example, in Vietnam only 63% of 2004 donor reported HIV disbursements could actually be tracked as having been spent. In Rwanda, while the Global Fund reported a $1.3 million disbursement to the MoH in 2003 for net purchases, none of these funds were spent that year due to supply constraints of long lasting nets. Thus before assuming that a given grant has been invested, it is critical to examine its end use and to monitor the time lag between disbursement and expenditures, which can reveal any administrative and/or implementation bottlenecks.