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36 THIRD WHO REPORT ON NEGLECTED TROPICAL DISEASES
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2.6.2 The role of domestic investment in driving progress to 2030
The World Bank has reported that the domestic revenues of low- and middle-income
countries amounted to US$ 7.7 trillion in 2012, compared with about US$ 134 billion in
official development assistance from traditional donors and US$ 43 billion from emerging
donors such as the BRIC countries (Brazil, Russia, India and China) and nongovernmetal
organizations (23). In other words, governments in low- and middle-income countries
already collect more than US$ 40 in domestic revenues for every dollar of foreign aid
received. The same World Bank report notes that the citizens of these countries received
about US$ 500 billion in officially recorded remittances from a diaspora of 215 million
emigrants working abroad. Considering both public and private financing, there is more
space than ever before for domestic investment in health. The question is how to realize the
potential of domestic investment for universal coverage against NTDs.
Multilateral development banks have a role to play in facilitating the shift in NTD financing
from grants to zero-interest loans to low-interest loans to non-concessional loans and
domestic revenues. The World Bank’s International Development Association (IDA) fund
has already contributed to leveraging domestic investment with a mix of grants and loans.
These have financed dedicated NTD projects, notably for schistosomiasis control in China,
Egypt and Yemen, as well as multisectoral projects, including water resource development
in the Senegal River basin. Countries have matched every dollar of IDA funds with about
two dollars of domestic revenues. The World Bank recently committed to working with
NTD programmes in Africa to access US$ 120 million in IDA funds. Another US$ 75
million project for combining preventive chemotherapy for NTDs with seasonal malaria
chemoprevention in the Sahel will leverage domestic funding in Burkina Faso, Mauritania
and Niger.
It is with the governments of endemic countries, however, that the ultimate decision lies
to make universal coverage against NTDs a domestic policy priority. One of the challenges
to the prioritization of NTD control for domestic investment is that it remains largely absent
from national health plans and budgets, let alone the plans and budgets of other sectors.
WHO and its partners have been providing assistance to countries in the use of the NTD
tool for integrated planning and costing, or TIPAC (58). WHO will be incorporating an
NTD module based on TIPAC within WHO’s sector-wide costing tool (59). The objective is
to present NTDs alongside other diseases within health plans and budgets.
Another challenge is that many endemic countries do not yet have a clear understanding
of how much (or little) domestic investment is directed towards NTD programmes
relative to foreign aid or relative to other priority disease programmes. WHO is working
with countries to track actual expenditures on NTDs through the WHO Health Accounts
Country Platform. Health accounts have been completed in 11 countries and at least five
low-income, high-burden countries in Africa are now tracking expenditures on NTDs as
part of their national statistics. Health accounts are ongoing or will start soon in another