NYU Researcher Finds that Donor Funding to Fight HIV in Sub-Saharan Africa Crowds Out Delivery of Some Non-HIV Health Services, while Strengthening Others


Karen Grépin's paper will appear in the July special issue of Health Affairs devoted to assessing the President's Emergency Plan for AIDS Relief.

Donor funding for HIV programs has increased rapidly over the past decade, raising questions about whether other health services in recipient-country health systems are being reduced or strengthened overall.

An investigation of the effects of increased HIV donor funding on non-HIV health services in Sub-Saharan Africa during 2002-09 provides evidence of both effects: HIV aid in some countries has crowded out the delivery of childhood immunizations, especially in countries with the lowest density of health care providers; at the same time, HIV donor assistance may have positively affected some maternal health services, such as prenatal blood testing.

Karen Grépin, assistant professor of global health policy at the Robert F. Wagner Graduate School of Public Service at New York University, reports on her findings in the July issue – out Tuesday, July 10 — of the journal Health Affairs. The July thematic issue is devoted to assessing the President’s Emergency Plan for AIDS Relief, the program of bilateral U.S. assistance begun in
2003 to support countries in their battle against HIV/AIDS, which has been described as the largest program of U.S. aid since the Marshall Plan.

The mixed results found by Grépin – the curbing of some non-HIV health services and the boosting of others – suggest that international HIV-focused donors should be more attentive to domestic resource constraints in recipient countries, such as limited numbers of health workers. In addition, Grépin writes, donors should integrate more fully with existing health systems, and should address these constraints up front to limit possible negative effects on the delivery of other health services.

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