Association of Development Assistance for Health With Disease Burden: A Longitudinal Analysis of Official Development Assistance for HIV/AIDS, Tuberculosis, and Malaria in 2005-2017

Background: Development assistance for health (DAH) has been considerably affected by the COVID-19 pandemic, underscoring the importance of clarifying how donor countries select recipient countries and how DAH is distributed. We investigated DAH allocation according to disease burden and whether DAH targeting has improved over time.Methods: We selected 92, 87, and 68 endemic countries for HIV/AIDS, tuberculosis, and malaria, respectively. Using the datasets published by the Institute for Health Metrics and Evaluation, the Organization for Economic Cooperation and Development, and the World Health Organization from 2005 to 2017, we analyzed the associations of disease burden, as the independent variable, with total DAH and DAH per capita as dependent variables. Disease burden was measured in terms of disability-adjusted life-years, the number of infected people, number of deaths, prevalence, incidence, and mortality rate. Ordinary least squares regression was used after log transformation to examine associations in each year. To evaluate trends in official development assistance (ODA) targeting, the likelihood ratio test of fixed-effects models was used to analyze slope changes in linear regression across years.Findings: The total amount of DAH and DAH per capita showed positive associations with disease burden, with increasing regression coefficients in 2005-2017. For instance, the slope of the association between DAH per capita and the disease burden of malaria became steeper over time (likelihood ratio, χ²=26·14, p>χ² <0·001). This indicates that resource allocation has improved over time.Interpretation: The findings of this study indicate that ODA targeting has been performed based on disease burden.Funding Information: None. Declaration of Interests: We declare no competing interests.