Page 13 - November 2021 IB FINAL

Cover Cover

In 2019, “development assistance for health to low-income HEALTH SPENDING AS A % OF GDP
and middle-income countries was $40·4 billion, or 0·5% of Tuvalu
total global health spending,” the paper states. “However,
in 2020, total development assistance for health (including American Samoa
development assistance for health for COVID-19) amounted to Vanuatu Cook Islands Federated States of Micronesia
$54·8 billion, a $14·0 billion (34·6%) increase from 2019.”
This assistance has been varied. Partner governments and Tokelau Tonga
international organisations have supplied vaccines, oxygen,
personal protection equipment (PPE), training, ventilators, Fiji
surge capacity, field hospitals, transport and even paid for Solomon Islands Guam
health workers’ lunches as the need has arisen.
In the Pacific, over 80% of health expenditure is publicly Samoa 5.3 2.6 12
funded by governments, through domestic revenue and high 2.2 Kiribati
levels of donor/partner funding. The remaining 20% comes Papua New Guinea 12.4
from out-of-budget donor assistance and private spending on 11.3 11.9
health services. Palau Northern Mariana Islands 11.9 Marshall Islands
A recent Pacific Heads of Health meeting heard anecdotal Nauru
evidence suggesting that budget allocations for health will Niue
hold up in 2022, but: “The impact of COVID-19 on health Source: Global Burden of Disease 2020 Health Financing Collaborator Network,
financing in Pacific countries depends not only on the extent, The Lancet 2021
duration, and severity of the economic contraction, but also
on general domestic revenues, on government borrowing saw that to some extent with COVID, as well. Some countries
and external financing, as well as on health’s share of public were able to spend the money quicker than others. And it’s all
expenditure, and how well that share is managed.” about absorptive capacity.”
Dr Ian Anderson, an Associate at the Development Policy Dr Vivili and others acknowledge the role of development
Centre with over 25 years of experience in development work aid in equipping hospitals, providing vaccines and support-
for the Australian Government, says government spending ing surge capability in Pacific nations. But the tendency of
on health tends to increase in scale and as a share of GDP as these efforts to steamroll past domestic responders has been
countries ‘develop’. Similarly, as life expectancy lengthens castigated by some.
and the aged population grows, the diseases requiring treat- PNG’s COVID controller and Police Commissioner, David Man-
ment and the cost of that treatment also grows. ning, says the international aid sector needs to shoulder some
“The counterargument is politics,” he says. “The amount of the blame for the crisis in Papua New Guinea, where the
of public expenditure on public health is essentially a politi- COVID response has exposed deep inadequacies in the health
cal decision. It really tells you how serious is any government system, and vaccination rates are extremely low.
about public health.” “At the national level the Department of Health has
“Without donor assistance, health systems in the Pacific become little more than a shell that is controlled by a cabal
will not be able to cope,” says Pacific Community (SPC) Dep- of multilateral agencies and international NGOs,” Manning
uty Director-General, Dr Paula Vivili. A medical professional claims.
who has worked in Tonga and New Zealand, Dr Vivili previous- “They undermined our data systems, they disobeyed my
ly led the SPC’s Public Health Division, which has been critical orders and set up parallel systems and advised a struggling
to regional efforts to address the COVID-19 pandemic. disease surveillance team accordingly,” he continued.
“[Donors] provide a lot of support for the public health
component of the work. Because the country’s own budgets, Testing positive
generally speaking, fund the curative, the hospital compo- Third or fourth wave notwithstanding, health leaders are
nent, the clinical component,” he continues. now looking at what we’ve learnt through COVID, and how
“Of course, everywhere you go, there’s always discussion these lessons can be applied in the longer term.
that we are always under-funding the public health aspect, In January 2020, a Joint Incident Management Team was set
the preventative component…That’s always easy for people up by the World Health Organisation and partners to coordi-
from the outside to say, until you work in the system, and nate the pandemic response across agencies.
realise that you still have to look after the people that are Dr Vivili applauds the bringing together of more than 20
sick.” partners through the team, saying it eased coordination and
Photo illustration: Albert Rolls ability”, but “personally, my view is that the donor support deal with COVID, but admits that some countries remain
delineation of responsibilities.
Dr Vivili remarks that “there’s a lot of talk about sustain-
He feels that countries are as prepared as they can be to
is here to stay, and it’s about how people can use this best to
untested by community transmission.
build their own systems and progress that way.”
“The big question, of course, is how sustainable this all is
He notes that for some Pacific states, the challenge is
actually spending the money, due to limited resources. “We
Continued on page 16
Islands Business, November 2021 13