Country size bias in global health: cross-country comparison of malaria policy and foreign aid

Springer Science and Business Media LLC - 2021
Tomas Jezek1
1Masaryk University, Brno, Czechia

Tóm tắt

AbstractBackgroundForeign aid has been shown to be favourably biased towards small countries. This study investigated whether country size bias also occurs in national malaria policy and development assistance from international agencies.MethodsData from publicly available sources were collected with countries as observational units. The exploratory data analysis was based on the conceptual framework with socio-economic, environmental and institutional parameters. The strength of relationships was estimated by the Pearson and polychoric correlation coefficients. The correlation matrix was explored by factor analysis.ResultsMalaria burden is strongly correlated with GDP per capita, total health expenditure per capita, HDI; moderately with latitude, weakly with elevation, urban population share, per capita funding from the Global Fund, PMI USAID, UK government and UNICEF. Small country status is strongly correlated with population size, land area, island status; moderately with development assistance received per capita, weakly with funding per capita from Global Fund, government NMP and PMI USAID. Policy score 1, a variable derived from our factor analysis and related to malaria endemicity, is significantly strongly correlated with the malaria burden, moderately with HDI, GDP per capita, total health expenditure per capita, PMI USAID funding; weakly with island status, urban population share, latitude, coastal population share, total government expenditure and trade openness, Global Fund funding, World Bank funding, UK government funding, and UNICEF funding per capita. Policy score 2, which captures variation not related to malaria endemicity, is significantly weakly related to the ICRG index, PMI USAID funding per capita and small country status.ConclusionsThe results suggest that malaria burden and economic development are bidirectionally related. Economic development can contribute to a reduction in the malaria burden. Country size does not negatively impact malaria burden, but it does account for greater development assistance per capita from selected international agencies. National malaria policy is associated with parameters related to public governance and is modified in small countries. Small country bias is present in the distribution of socio-economic resources and the allocation of foreign aid. Small countries are characterized by distinct environmental and socio-political properties.

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Tài liệu tham khảo

Dudley L, Montmarquette C. A model of the supply of bilateral foreign aid. Am Econ Rev. 1976;66(1):132–42.

Gallup JL, Sachs JD, Mellinger AD. Geography and economic development. Int Reg Sci Rev. 1999;22(2):179–232.

Easterly W, Levine R. Tropics, germs, and crops: how endowments influence economic development. J Monet Econ. 2003;50(1):3–39.

Braveman PA. Epidemiology and (neo-) colonialism. J Epidemiol Community Health. 2001;55(3):160–1.

Prussing E. Critical epidemiology in action: research for and by indigenous peoples. SSM-Popul Health. 2018;6:98–106.

World Health Organization. Action and Investment to Defeat Malaria 2016–2030-for a Malaria-Free World. Technical report, Geneva; 2016.

Okorosobo T, Okorosobo F, Mwabu G, Orem JN, Kirigia JM. Economic burden of malaria in six countries of Africa. Eur J Bus Manag. 2011;3(6):42–63.

Williams HA, Durrheim D, Shretta R. The process of changing national malaria treatment policy: lessons from country-level studies. Health Policy Plan. 2004;19(6):356–70.

Online Browsing Platform (OBP) [Internet]. Available from: https://www.iso.org/obp/ui. Accessed 8 May 2020.

Hagenlocher M, Castro MC. Mapping malaria risk and vulnerability in the United Republic of Tanzania: a spatial explicit model. Popul Health Metrics. 2015;13(1):2.

Ekström J. The phi-coefficient, the tetrachoric correlation coefficient, and the Pearson-Yule Debate; 2011.

Yeomans KA, Golder PA. The Guttman-Kaiser criterion as a predictor of the number of common factors. Statistician. 1982:221–9.

Crowards T. Defining the category of ‘small’states. J Int Dev. 2002;14(2):143–79.

Jalan B. Problems and Policies in Small Countries. Lond Croom Helm. 1982. p. 39–48.

Downes AS. On the statistical measurement of smallness: a principal component measure of country size. Soc Econ Stud. 1988:75–96.

Schiavo-Campo S. Some considerations on development aid to small countries. Dev Policy Small States, Selwyn P (Ed). Croom Helm Lond. 1975.

Sachs JD, Warner A, AAslund A, Fischer S. Economic reform and the process of global integration. Brook Pap Econ Act. 1995;1995(1):1–118.

Knack S, Keefer P. Institutions and economic performance: cross-country tests using alternative institutional measures. Econ Polit. 1995;7(3):207–27.

Sagar AD, Najam A. The human development index: a critical review1. Ecol Econ. 1998;25(3):249–64.

Tarnoff C. US Agency for International Development (USAID): Background, operations, and issues. Congressional Research Service Washington, DC; 2015.

Global Malaria Programme WHO. Policy Brief for the Implementation of Intermittent Preventive Treatment of Malaria in Pregnancy using Sulfadoxine-Pyrimethamine (IPTp-SP). 2013;.

Hay SI, Guerra CA, Tatem AJ, Noor AM, Snow RW. The global distribution and population at risk of malaria: past, present, and future. Lancet Infect Dis. 2004;4(6):327–36.

Jain AK. The political economy of corruption. Vol. 2. London: Routledge; 2001.

Dhiman RC, Pahwa S, Dhillon GPS, Dash AP. Climate change and threat of vector-borne diseases in India: are we prepared? Parasitol Res. 2010;106(4):763–73.

Cox J, Craig M, Le Sueur D, Sharp B. Mapping malaria risk in the highlands of Africa; 1999.

Feachem RG, Phillips AA, Hwang J, Cotter C, Wielgosz B, Greenwood BM, et al. Shrinking the malaria map: progress and prospects. Lancet. 2010;376(9752):1566–78.

Hay SI, Guerra CA, Tatem AJ, Atkinson PM, Snow RW. Urbanization, malaria transmission and disease burden in Africa. Nat Rev Microbiol. 2005;3(1):81–90.

Sachs J, Malaney P. The economic and social burden of malaria. Nature. 2002;415(6872):680.

Liang L-L, Mirelman AJ. Why do some countries spend more for health? An assessment of sociopolitical determinants and international aid for government health expenditures. Soc Sci Med. 2014;114:161–8.

Gupta S, Davoodi H, Tiongson E. Corruption and the provision of health care and education services. In: The political economy of corruption. London: Routledge; 2001. p. 123–53.

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