Rich countries would have to give $25 billion to $70 billion more each year for developing nations to meet the health-care needs set out in the Millennium Development Goals, a World Bank study said on Thursday. 

Beyond the targets set for 2015 by leaders of the Group of Eight rich countries last July is the momentum of a burgeoning global population the World Bank expects to reach 7.5 billion by 2020 and 9 billion by 2050, the study found. 

"While birth rates are declining, because you still have so many women in the child-bearing years -- because of population momentum -- global births don't begin to decline until 2030 so in absolute numbers you still have a lot more births," said George Schieber, one of the report's co-authors. 

"As populations age, then you get people in the very high expenditure groups of the elderly and noncommunicable diseases, so they're going to be putting a lot more pressure on the health system," Schieber added. 

Health-care systems worldwide are already struggling to cope with sharply rising costs in dealing with HIV/AIDS and efforts to head off the possibility of a human pandemic of bird flu, the report shows. 

But demographic changes alone over the next 20 years will mean most low- and middle-income countries will face 2 to 3 percent annual increases in health-care spending, it said. 

"At least in communicable diseases there are low-cost methods of preventing it or treating it so it really has to do with the momentum and the demographics," Schieber said. 

One major obstacle is government resources in meeting these growing needs. The report cited International Monetary Fund programs that preclude countries from using increased grant funding for health spending like hiring more health workers. 

Demographic changes mean health spending is expected to rise by 14 percent in Europe and Central Asia over the next 20 years, 45 percent in South Asia, 47 percent in Latin America and the Caribbean, 52 percent in Sub-Saharan Africa and 62 percent in the Middle East and North Africa, the study showed. 

BETTER DONOR COORDINATION URGED 

Donor aid from governments, multilateral lenders and private foundations has grown to $10 billion in 2003 from $6 billion in the late 1990s, but only half of those funds make their way into national budgets with the rest going to consultants and administration. 

"Donor finance is volatile and unpredictable. The way we provide aid needs to change if it is to be effective," said Pablo Gottret, the report's other co-author. "Aligning our priorities is important." 

Rwanda, for example, currently has more than 50 donors in its health sector funding a variety of competing initiatives and hiring away scarce health-care workers from the public sector. 
"These are very good programs that are competing with each other rather than coordinating," said Gottret, who returned from Rwanda last week, adding that developing countries carry 90 percent of the world's health burden, but account for 12 percent of spending. 

Attempts to harmonize aid in education to match individual countries' policy goals is a good example for health donors to follow to maximize the effectiveness of their financing, said Jean-Louis Sarbib, senior vice president for the World Bank's human development network. 

"We need more (money). We need better coordination. We need an outcome focus," Sarbib said. "We need better evaluation."