Unsustainable funding of high-burden tuberculosis control programmes: who is responsible?

The literature suggests that crowding-out effects of government funding for health happen in low-income countries with a high HIV burden. In a survey, we investigated the hypothesis that domestic funding for TB control has fallen in 11 low-income, high-TB-burden countries in the context of changes in gross domestic product (GDP), development assistance inflows and national health expenditures. We found that despite rises in GDP per capita between 2003 and 2009, health expenditure as per cent of GDP fell or stayed the same for the majority of these countries. Although TB control budgets increased for all 11 countries in absolute terms, 6 countries reduced government contribution to TB control. For health programmes to become sustainable in the long run, we suggest increases in donor funding for health to be accompanied by requirements to increase domestic funding for health. We thereby attribute responsibility to avoid crowding-out effects to donors and governments alike. Moreover, it is the responsibility of both to ensure essential items to be funded by government sources to avoid a collapse of programmes once aid is withdrawn.