“Dhaka’s population has grown from 7 million in 1991 to 11 million today. Clearly the city is not prepared for this, compelling many people to live in the open, covered only by bamboo, sacking, polythene or cardboard. Such unprecedented urban growth is placing a strain on municipal management and, as ever, the burden falls heaviest on the poor. Local governments especially are proving ill equipped to cope with the additional demands for land, housing, food, services and infrastructure, and have difficulty with the environmental and social costs of rapid urbanization.It is now accepted by most international agencies and professionals that urbanization is inevitable, and a precondition to economic and social development. It is now acknowledged that for all their problems, urban areas are the primary engines of economic growth, as well as social and technical innovation. The evidence shows that cities generate a disproportionately higher ratio of central government revenues and economic activity relative to their population levels. The challenge is therefore to evolve appropriate and sustainable ways of managing the urbanization process, rather than seeking to prevent it.”
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Advocates for many developing-world health and population issues have expressed concern that the high level of donor attention to HIV/AIDS is displacing funding for their own concerns. Even organizations dedicated to HIV/AIDS prevention and treatment have raised this issue. However, the issue of donor displacement has not been evaluated empirically.
This paper attempts to do so by considering donor funding for four historically prominent health agendas—HIV/AIDS, population, health sector development and infectious disease control—over the years 1992 to 2005. The paper employs funding data from the Organization for Economic Cooperation and Development’s (OECD) Development Assistance Committee, supplemented by data from other sources.
Several trends indicate possible displacement effects, including HIV/AIDS’ rapidly growing share of total health aid, a concurrent global stagnation in population aid, the priority HIV/AIDS control receives in US funding, and HIV/AIDS aid levels in several sub-Saharan African states that approximate or exceed the entirety of their national health budgets. On the other hand, aggregate donor funding for health and population quadrupled between 1992 and 2005, allowing for funding growth for some health issues even as HIV/AIDS acquired an increasingly prominent place in donor health agendas. Overall, the evidence indicates that displacement is likely occurring, but that aggregate increases in global health aid may have mitigated some of the crowding-out effects.
The writer is an Associate Professor of Public Administration, The Maxwell School of Syracuse University, Syracuse, NY 13244–1020, USA. Tel: +1 315–443–4928. Fax: +1 315–443–9734.
Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2007; all rights reserved.