Misfinancing global health: a case for transparency in disbursements and decision making.

To address the gap between health investments and financial flows worldwide, we identified the patterns in allocation of funds by the four largest donors--ie, the World Bank, Bill & Melinda Gates Foundation (BMGF), the US Government, and the Global Fund to Fight HIV/AIDS, Tuberculosis and Malaria--in 2005. We created a disbursement database with information gathered from the annual reports and budgets. Funding per death varied widely according to type of disease--eg, US$1029.10 for HIV/AIDS to $3.21 for non-communicable diseases. The World Bank, US Government, and Global Fund provided more than 98% of their funds to service delivery, whereas BMGF gave most of its funds to research. BMGF grants in 2005 were given largely to private research organisations, universities, and civil societies in rich countries, whereas the US Government and Global Fund primarily disbursed grants to sub-Saharan Africa. Publicly available data for global health disbursements is incomplete and not standardised. Continued attention is needed to develop country ownership, particularly in planning and priority setting.