Jessica Hale, Donna J. Barry, Billy Andre and Brian Hutchinson

 

Intro

As the global fight against infectious diseases, such as HIV/AIDS, malaria, and tuberculosis, improves the growing burden of non-communicable diseases (NCDs) is becoming more apparent. This category of diseases, which includes heart disease, cancer, and diabetes, is the cause of 70% of all deaths, or 15 million premature deaths, ages 30-70, each year [1]. In 2012, cancer alone was responsible for 8.2 million deaths, representing 21.7% of all NCD deaths. By 2030, the number of cancer deaths is projected to reach 12.6 million [2].

While the high level of burden that cancer and NCDs impose is indisputable, the global community of donors has been slow to respond. NCDs are often recognized as a problem in high-income countries, but the funding focus remains on infectious diseases in developing countries. According to recent estimates, alignment is lacking between NCD burden and funding, accounting for 49.8% of the burden while only receiving 1.5% of all development assistance for health [3].

These tracking studies have yet to examine the breakdown of NCD funding to see how donor priorities relate to high burden NCDs, such as cancer, heart disease, chronic respiratory diseases, and diabetes. Seeking further disaggregation, a team at RTI International began tracking NCD funding in 2016. The database of NCD projects can be used to evaluate how and where funding is being allocated and improve resource spending moving forward. The GO Map is a perfect example of how the database can be used improve knowledge about the funding gap as it pertains to cancer.

The results can help inform and educate a wide range of players, from donor countries’ development agencies to non-profits. The recent United Nations High-level Meeting on NCDs and World Cancer Congress provide the perfect opportunity and audience to present these findings [4].

Methods

RTI tracked data through national, international and organizational databases seeking to find external funding coming from rich countries to developing countries. Projects in these databases were reviewed by a team of coders according to a codebook defined at the start and modified throughout the search process. NCDs were defined broadly for the purposes of this research, including not only the four most widely constituted NCDs (cardiovascular disease, cancer, chronic respiratory disease, and diabetes), but also mental disorders, sensory disorders, disability, and oral health. A list of 270 keywords was compiled, databases were searched during the years 2010 to 2015, and all project funding was adjusted to be equivalent to 2015 USD.

Funds tracked include spending in and for low- and middle-income countries (LMICs) on projects that:

  • deliver and improve NCD services, including through integrated programs,
  • carry out health promotion or disease prevention actions,
  • strengthen health systems for purposes of NCD care in LMICs and
  • support activities within and outside of the health sector that provide care or other services for populations living with an NCD.

 

Broad overview of data

The RTI database provides information on a wide-range of NCDs, but for the purposes of working with The GO Map, all RTI’s projects relating to cancer were identified and shared.

In the case of cancer, the majority of the projects could not be allocated to a specific country or region. However, of the projects that did specify a location in the period 2010-15, Africa received the most (81.3 million), followed by the Americas (69.7 million), the Eastern Mediterranean (42.8 million), Europe (19.7 million), South-East Asia (7.4 million), and the Western Pacific (6.8 million).

The largest recipients of funding over the six-year period include Argentina (51.7 million), Jordan (24.8 million), Kenya (21.7 million), and Uganda (18.5 million). Over 60% of the country recipients received less than 1 million USD, with Macedonia FYR (3,000 USD), Cape Verde (3,400 USD), and the Dominican Republic (4,400 USD) taking the bottom spots.

It is also interesting to note the fluctuations in cancer funding over the six-year period. There is a general upward trend in funding from 2010 to 2013, but then funding drops off drastically. 2013 is cancer funding’s peak year, totaling 142.1 million, but funding falls to 45.0 million in 2014 with only a small increase to 52.4 million in 2015.

Finally, while most of the cancer projects do not specify the type of cancer, of the projects that do, cervical cancer is the most funded (69.3 million), followed by colorectal cancer (52.9 million).

Where/How to find data on The GO Map

724 projects were uploaded onto The GO Map from RTI’s database. To find these projects, type RTI International in the category “All Organizations”, under “Filters”. From there you can view each of the projects’ details, which includes the project description, name and location of the donor, the type of cancer, and project length. For the purposes of the upload, all projects provide an end date one-year after their start date. The RTI projects are housed and searchable among the rest of the GO Map projects.

Map of the Data

In addition to the project-level uploads, a map of the country-level funding is included with this blog. The map shows the amount of cancer funding received from 2010-2015, darker colors translating to greater funding. Hovering over each country allows users to see the amount the country received.

Conclusion

Identifying how much is being spent on NCDs is the first step in making the case for action. With NCD’s growing burden around the world, mobilization is needed now if we hope to get things under control. This not only means more resources, but also devoting more time and energy to come up with new and creative solutions for the complex problems NCDs pose. All hands, from ministries of health to large and small donors, will be needed to determine the best path forward.

 

References

1. WHO, Noncommunicable Diseases Progress Monitor, 2017. 2017, World Health Organization: Geneva.

2. WHO, Global status report on noncommunicable diseases 2014. 2014, World Health Organization: Geneva.

3.  Dieleman, J.L., et al., Global Health Development Assistance Remained Steady In 2013 But Did Not Align With Recipients’ Disease Burden. Health Affairs, 2014. 33(5): p. 878–886.

4.  WHO. Third United Nations High-level Meeting on NCDs. Noncommunicable diseases and their risk factors 2018  [cited 2018 Jul 25, 2018]; Available from: http://www.who.int/ncds/governance/third-un-meeting/en/.