1 DEVELOPMENT ASSISTANCE FOR HEALTH (DAH): RECENT TRENDS AND RESOURCE ALLOCATION Catherine Michaud, MD, PhD Paper prepared for the Second Consultation Commission on Macroeconomics and Health World Health Organization, Geneva October 29-30, 2003. This paper complements the CMH working paper “Development Assistance for Health: Average Commitments 1997-1999”. The first part reviews trends in development assistance for health (DAH) provided by bilateral and multilateral agencies; the European Community (EC); the Global Fund to fight AIDS, malaria and tuberculosis (GFATM); and grants provided by the Bill and Melinda Gates Foundation (BMGF). Together these sources provide an estimated ninety percent of total DAH. The second part presents a detailed analysis of geographic allocation of funds and for major components of interest, namely AIDS, malaria and tuberculosis. The last part discusses the major implications of key findings. I. TRENDS IN DEVELOPMENT ASSISTANCE FOR HEALTH B ETWEEN 1997 AND 2002 This period corresponds to a period of decline in overall ODA coupled with a new understanding of the importance of health as a major determinant of economic growth. Clear targets have been set as part of the Millennium Development Goals (MDG) to assess progress. The report of the CMH provided estimates of the substantial increase in DAH that would be needed to have a significant health impact. The first question therefore is “how far have we advanced towards a substantial increase in DAH”?  Total ODA begins recovery in 2002 After a long period of decline in total official development assistance (ODA) during the past decade, the OECD reported a real increase of 5% in ODA provided by members countries of the OECD’s Development Assistance Committee (DAC) from 2001 to 2002. The total amounted to $57 billion and hopefully signals the beginning of a recovery from the steady decrease of total ODA during the 1990s to an all time low in development assistance over the past three years. In 2002 total ODA increased from 0.22% to 0.23 % of combined gross national income (GNI). This is still far from the target of 0.7% of GNI set years ago. Health ODA feared better than total ODA. The share of total bilateral ODA allocated to the health sector (including health and population) increased from 3.8 percent in 1990 ($2.2 billion) to 6.8 percent in 2002 ($2.9 billion). In spite of this steady increase,