The share of total development aid for health declined slightly in the 1980s, from 7 to 6%. In 1990, donors disbursed about US$4,800 million of assistance for health, or about 2.5% of all health spending in developing countries. In low-income countries in Africa, aid accounts for an average 20% of the health spending, and for over half in Burundi, Chad, Guinea-Bissau, Mozambique and Tanzania. In other developing regions, aid amount of 2% or less of health expenditures.
After growing rapidly in the 1970s, aid for health stagnated during the 1980s. As a share of official development assistance, aid for health declined from an average of 7% for the period 1981-85 to 6% during 1986-90. Total aid flows to the health sector in 1990 were $4,800 million comprising almost $4,000 million in official development assistance and $800 million from NGOs and foundations. This amounts to about one dollar per person in developing countries. Bilateral agencies accounted for the largest share (40%), followed by UN agencies (33%), NGOs (17%), development banks (8%) and foundations (2%).
The trend is for donors to provide aid for health through multilateral channels. The share of multilateral assistance has grown from 25% in 1980 to 40% in 1990 and is likely to exceed 50% in 1995. Disbursements of World Bank funds for health have risen from about $350 million in 1992 to about $1,000 million, making it the largest single source of external funding for health. In 1990, the World Bank proposed to the donor community a 3% annual increase in aid during the 1990s, to be targeted at poverty-reducing activities, including basic health care; it also recommended an immediate restoration of the health aid budget to 7% of total development aid. Similarly, UNDP proposed in its Human Development Report 1993 (also endorsed by UNICEF) that 20% of aid be spent on health, education, water and sanitation, and environmental protection for the world's poor.
An additional $2,000 million a year from donors would meet about one-quarter of the costs of stabilizing the AIDS epidemic ($500 million) and one-sixth of the extra resources needed to provide the public health and clinical care package for low-income countries ($1,000 million of the $10,000 million required).