In Ebola’s Wake, How Should the World be Financing Global Health?

While individual donations cannot operate in lieu of government or multilateral funding, engaging the general public in global health issues and providing them with easy ways to donate could be extremely effective

In Ebola’€™s Wake, How Should the World be Financing Global Health?

by Sara Gorman*, PhD 

 Department of Health Policy & Management, Columbia University Mailman School of Public Health 

Why did the Ebola epidemic get so out of control? This is the question on the minds of world leaders, members of the global health community, and members of the general public as we reflect on the continuing tragedy of Ebola in West Africa.

Global health funding has typically come mainly from governments and multilateral institutions such as the World Health Organization (WHO). But as we continue to see disappointing progress toward some of the Millennium Development Goals (MDGs), especially reducing maternal mortality, the global health community has been increasingly calling for a restructuring of the funding landscape. Of course, the global health financing landscape has already changed dramatically since 1990, with new figures such as the Gates Foundation and the GAVI Alliance emerging and contributing to a dramatic increase in development assistance for health, a figure that reached $28 billion in 2010. Yet in a world where 800 women still die each day due to preventable causes related to pregnancy and childbirth , it becomes more and more important to examine what we are currently doing and how it can be done better.

Increasingly budget-strapped governments are shying away from global health funding, ramping up their budgets only when disasters such as Ebola come into view. This is clearly not an ideal state of affairs. Some have suggested that governments view investment in global health as an inevitable loss. As a result, some have suggested a different approach: impact investing and socially-responsible investments. Impact investments are investments made into companies or organizations with the expectation of a measurable, beneficial social or environmental impact as a solid return on the investment. Other models focus on financing techniques to spur more innovation for neglected diseases in the pharmaceutical industry, such as advance market commitments and transferable market exclusivity, in which a company can gain an extension on a patent for a drug of its choice in exchange for investing in and successfully creating a drug for a neglected or unprofitable disease area.

Yet there is another tremendous opportunity that remains largely untapped: individual donations. While individual donations cannot operate in lieu of government or multilateral funding, engaging the general public in global health issues and providing them with easy ways to donate could be extremely effective. Studies show that 95.4% of U.S. households gave to charity in 2013, and that individual donations constituted the largest source of charitable donations at $241.32 billion (or 72% of all U.S. charitable giving), compared with foundations ($50.28 billion) and corporations ($16.76 billion). There is reason to believe that the public is interested in global health issues but is not quite sure where to start. In a Kaiser Family Foundation survey from 2012, 52% of people said that the media pays too little attention to health issues in developing countries. When given a list of health issues in developing countries and asked to rank priorities, the public had a difficult time choosing, and about 1/3 of people claimed that all 12 named issues should be “€œone of the top”€ priorities. What this suggests is that the general public, at least in the U.S., is interested in engaging more with global health and believes that more funding is the “€œright thing to do”€, but many feel overwhelmed by the number of dire health issues in developing countries and simply does not know where to start, what exactly to donate to, and how to find worthy sources of donation. Finding ways to better engage this portion of the population, including through more extensive coverage of everyday health problems in developing countriesrather than just crises such as Ebola and perhaps through more extensive online resources to nudge the public in the right direction is sorely needed.

The Ebola crisis is a terrible tragedy. But it also represents an important opportunity not only to re-evaluate “€œbusiness as usual”€ but also to engage an interested and concerned public in the more extensive needs of developing country health systems. We should not let this extremely important opportunity pass us by.


*Sara Gorman, PhD is an MPH candidate in Health Policy and Management at Columbia University Mailman School of Public Health. She has written extensively about global health, HIV/AIDS policy, and women’€™s health, among other topics, for a variety of health and medical journals, including PLoS Medicine and International Journal of Women’€™s Health. She is currently working as a consultant for Janssen (the pharmaceutical companies of Johnson & Johnson) in Global Public Health division. She has worked in the policy division at the HIV Law Project and as a researcher at the Epidemiology Department at Harvard School of Public Health. She has also analyzed mental health policy under the ACA for the Vera Institute of Justice and researched the effectiveness of semi-mobile HIV clinics in rural Kenya for HealthRight International.