Global spending on health in developing nations has increased massively in recent years, but research published today in the Lancet questions how well spent it really is.

So called ‘development assistance for health’ went up from $5.6 billion in 1990 to $21.8 billion in 2007, according to a study funded by the Bill & Melinda Gates Foundation. But, while poor countries did generally receive a bigger share of this pot than richer nations, some are missing out.

Angola, Ukraine and Thailand are among the 30 poorer countries with the most illness and premature death. They are also among the twelve countries missing from the list of those nations receiving most health aid, says Christopher Murray, study author and researcher at the University of Washington.

“With no one tracking this massive growth in spending, it’s no wonder that some countries receive far more than their neighbours for no immediately apparent reason,” he says (press release). “We’re hoping that this attempt to count money that has never been counted before in a careful and consistent way will lead to greater transparency and better use of health resources.”

From Forbes:

It’s a “critical piece of work” says Jennifer Kates, vice president of the health care policy nonprofit Kaiser Family Foundation, because it’s the first time researchers compiled a comprehensive list of the sources and cumulative amount of global health financing. A major obstacle to improved efficiency, she says, is the lack of coordination between donors. Without a central, public database for aid, donors often don’t realize similar programs are funded in the same country.

AP notes that Murray’s report also highlights that which disease gets money doesn’t necessarily correlate with which is the biggest killer. AIDS gets 23% of spending despite causing fewer than 4% of deaths.

“Funds in global health tend to go to whichever lobby group shouts the loudest, with AIDS being a case in point,” Philip Stevens of think tank the International Policy Network told the newswire.

In a second study published by the Lancet, the UN’s World Health Organisation warns that massive growth of private health funding comes with some risks

PA explains:

The WHO said although global health initiatives (GHIs) had benefited millions, there was evidence that they held back the health systems of poor countries.

Services not targeted by GHIs were sometimes left behind and aid from outside could lead to countries reducing their own health spending. GHIs had both exposed and on occasions contributed to weaknesses in the governance of health systems in poorer countries, said the WHO authors. Reliance on GHI supply structures to obtain drugs and medical equipment could compromise a country’s opportunities to develop its own, said the report.

Global health initiatives had also had an adverse effect on health service workforces. In some cases, GHI projects had poached healthcare staff from the public sector. In others, they had been linked to an increased imbalance between workforces in urban and rural areas.