Countdown to 2015: assessment of donor assistance to maternal, newborn, and child health between 2003 and 2006

doi:10.1016/S0140-6736(08)60561-9

The Lancet

Volume 371, Issue 9620, 12–18 April 2008, Pages 1268-1275

https://doi.org/10.1016/S0140-6736(08)60561-9 Get rights and content

Summary

Background

To track donor assistance to maternal, newborn, and child health-related activities is necessary to assess progress towards Millennium Development Goals 4 and 5 and to foster donor accountability. Our aim was to analyse aid flows to maternal, newborn, and child health for 2005 and 2006 and trends between 2003 and 2006.

Methods

We analysed and coded the complete aid activities database for 2005 and 2006 with methods that we developed previously to track official development assistance. For the 68 Countdown priority countries, we report two indicators for use in monitoring donor disbursements: official development assistance to child health per child and official development assistance to maternal and neonatal health per livebirth.

Findings

Donor disbursements increased from US$2119 million in 2003 to $3482 million in 2006; funding for child health increased by 63% and that for maternal and newborn health increased by 66%. In the 68 priority countries, child-related disbursements increased from a mean of $4 per child in 2003 to $7 per child in 2006; disbursements for maternal and neonatal health increased from $7 per livebirth in 2003 to $12 per livebirth in 2006. Nonetheless, disbursements fell in some countries. After adjustment for other determinants, countries with higher under-5 mortality received more official development assistance per child, but official development assistance to maternal and newborn health did not seem to be well targeted towards countries with the greatest maternal health needs.

Interpretation

Donor resource tracking should be continued to help hold donors accountable and encourage targeting of resources to countries with greatest needs.

Funding

Partnership for Maternal, Newborn and Child Health.

Introduction

Although there exists a lack of clarity on what constitutes an adequate target of aid disbursement to improve maternal, newborn, and child health to acceptable levels, evidence broadly points towards a substantial funding gap between what is needed to meet Millennium Development Goal (MDG) targets and what is currently invested in developing countries.1, 2, 3 To ensure that sufficient resources become available, donors will need to play their part in providing additional funding to support national governments in meeting agreed targets. Monitoring of aid disbursements to maternal, newborn, and child health to those countries with the greatest need is an important part of the process to assess progress and promote donor accountability.

We have previously developed and tested a method of tracking official development assistance in support of maternal, newborn, and child health-related interventions and services to recipient countries.⁴ Our findings suggested that levels of official development assistance were broadly inadequate to make a substantial contribution towards filling the funding gap. This work also provided some indication that donor spending could be better targeted to countries with the greatest health needs, since the data showed substantial variation in per beneficiary donor assistance between priority countries.

Here, we update estimates of official development assistance to maternal, newborn, and child health to include the years 2005 and 2006, which allows us to undertake a more extensive analysis of trends over time. Specifically, we examine whether there has been a sustained increase in official development assistance to maternal, newborn, and child health and hence whether donors are living up to their promises to support countries to achieve MDG targets. Additionally, the determinants of aid allocations to developing countries are explored to elucidate the direction and intensity of financial flows to maternal, newborn, and child health. This study is part of the Countdown initiative, a collaborative effort that aims to support countries in meeting their commitments to global goals through monitoring mechanisms and effective use of information collected.

Section snippets

Methods

We analysed and coded the complete aid activities database for the years 2005 and 2006 with methods described previously.⁴ We included all 22 donor countries and the European Union represented in the Development Assistance Committee of the Organisation for Economic Co-operation and Development (OECD). Additionally, we included the World Bank, UNICEF, the GAVI Alliance, and the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) as multilateral development organisations or global

Results

The volume of aid to maternal, newborn, and child health-related activities amounted to US$2935 million in 2005 and $3482 million in 2006 (table 2), representing just 3% of gross development assistance disbursements.⁷ As in previous years, child health expenditure accounted for more than two-thirds of all official development assistance for these activities. Bilateral donors accounted for almost two-thirds of total aid to maternal, newborn, and child health (table 2). Together, the GAVI

Discussion

The volume of official development assistance to maternal, newborn, and child health rose from $2119 million in 2003 to $3482 million in 2006, with increases of 63% for child health and 66% for maternal and newborn health. There was improved targeting to the 68 priority countries, with an almost doubling of disbursement per beneficiary. Both multilateral agencies and bilateral donors increased their contribution between 2003 and 2006 on average by 57%, whereas disbursements from global health

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All four approaches indicated substantial increases over time in global aid for RMNCH, but estimates of aid amounts and year-on-year trends differed substantially, especially for individual donors and recipient countries. Muskoka (US$ 13·0 billion in 2013, constant 2015 US$) and Countdown's RMNCH estimates ($13·1 billion in 2013) tended to be the highest and most similar, although they often indicated different year-on-year trends. IHME produced lower estimates ($10·8 billion in 2013), which often indicated different trends from the other approaches. The OECD policy marker produced by far the lowest estimates ($2·0 billion in 2013) because half of bilateral donors did not report on it consistently and those who did tended to apply it narrowly. Estimates differed across approaches primarily because of differences in methods for distinguishing aid for RMNCH from aid for other purposes; adjustments for inflation, exchange rates, and under-reporting; whether donors were credited for their support to multilateral institutions; and the handling of aid to unspecified recipients.
The four approaches are likely to lead to different conclusions about whether individual donors and recipient countries have fulfilled their obligations and commitments and whether aid was sufficient, targeted to countries with greater need, or effective. We recommend that efforts to track aid for the Sustainable Development Goals reflect their multisectoral and interconnected nature and make analytical choices that are appropriate to their objectives, recognising the trade-offs between simplicity, timeliness, precision, accuracy, efficiency, flexibility, replicability, and the incentives that different metrics create for donors.
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Tracking aid flows helps to hold donors accountable and to compare the allocation of resources in relation to health need. With the use of data reported by donors in 2015, we provided estimates of official development assistance and grants from the Bill & Melinda Gates Foundation (collectively termed ODA+) to reproductive, maternal, newborn, and child health for 2013 and complete trends in reproductive, maternal, newborn, and child health support for the period 2003–13.
We coded and analysed financial disbursements to reproductive, maternal, newborn, and child health to all recipient countries from all donors reporting to the creditor reporting system database for the year 2013. We also revisited disbursement records for the years 2003–08 and coded disbursements relating to reproductive and sexual health activities resulting in the Countdown dataset for 2003–13. We matched this dataset to the 2015 creditor reporting system dataset and coded any unmatched creditor reporting system records. We analysed trends in ODA+ to reproductive, maternal, newborn, and child health for the period 2003–13, trends in donor contributions, disbursements to recipient countries, and targeting to need.
Total ODA+ to reproductive, maternal, newborn, and child health reached nearly US$14 billion in 2013, of which 48% supported child health ($6·8 billion), 34% supported reproductive and sexual health ($4·7 billion), and 18% maternal and newborn health ($2·5 billion). ODA+ to reproductive, maternal, newborn, and child health increased by 225% in real terms over the period 2003–13. Child health received the most substantial increase in funding since 2003 (286%), followed by reproductive and sexual health (194%), and maternal and newborn health (164%). In 2013, bilateral donors disbursed 59% of all ODA+ to reproductive, maternal, newborn, and child health, followed by global health initiatives (23%), and multilateral agencies (13%). Targeting of ODA+ to reproductive, maternal, newborn, and child health to countries with the greatest health need seems to have improved over time.
The increase in reproductive, maternal, newborn, and child health funding over the period 2003–13 is encouraging. Further increases in funding will be needed to accelerate maternal mortality reduction while keeping a high level of investment in sexual and reproductive health and in child health.
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Citation Excerpt :
Agreement is needed as to which agency should take the lead. The results shown in this paper are subject to the same limitations with regard to the methods that have been acknowledged previously.12–15 The first challenge relates to separating funding to R*, maternal and newborn health, and child health, as well as the programme components therein.
Tracking of aid resources to reproductive, maternal, newborn, and child health (RMNCH) provides timely and crucial information to hold donors accountable. For the first time, we examine flows in official development assistance (ODA) and grants from the Bill & Melinda Gates Foundation (collectively termed ODA+) in relation to the continuum of care for RMNCH and assess progress since 2003.
We coded and analysed financial disbursements for maternal, newborn, and child health (MNCH) and for reproductive health (R*) to all recipient countries worldwide from all donors reporting to the creditor reporting system database for the years 2011–12. We also included grants from the Bill & Melinda Gates Foundation. We analysed trends for MNCH for the period 2003–12 and for R* for the period 2009–12.
ODA+ to RMNCH from all donors to all countries worldwide amounted to US$12·2 billion in 2011 (an 11·8% increase relative to 2010) and $12·8 billion in 2012 (a 5·0% increase relative to 2011). ODA+ to MNCH represents more than 60% of all aid to RMNCH. ODA+ to projects that have newborns as part of the target population has increased 34-fold since 2003. ODA to RMNCH from the 31 donors, which have reported consistently since 2003, to the 75 Countdown priority countries, saw a 3·2% increase in 2011 relative to 2010 ($8·3 billion in 2011), and an 11·8% increase in 2012 relative to 2011 ($9·3 billion in 2012). ODA to RMNCH projects has increased with time, whereas general budget support has continuously declined. Bilateral agencies are still the predominant source of ODA to RMNCH. Increased funding to family planning, nutrition, and immunisation projects were noted in 2011 and 2012. ODA+ has been targeted to RMNCH during the period 2005–12, although there is no evidence of improvements in targeting over time.
Despite a reduction in ODA+ in 2011, ODA+ to RMNCH increased in both 2011 and 2012. The increase in funding is encouraging, but continued increases are needed to accelerate progress towards achieving MDGs 4 and 5 and beyond.
Bill & Melinda Gates Foundation.

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ArticlesCountdown to 2015: assessment of donor assistance to maternal, newborn, and child health between 2003 and 2006

Summary

Background

Methods

Findings

Interpretation

Funding

Introduction

Section snippets

Methods

Results

Discussion

Lancet

Eur J Pol Econ

J Dev Econ

Eur Econ Rev

World Dev

J Int Econ

Estimated global resources needed to attain universal coverage of maternal and newborn health services

Bull World Health Organ

A financial road map to scaling up essential child health interventions in 75 countries

Bull World Health Organ

Articles
Countdown to 2015: assessment of donor assistance to maternal, newborn, and child health between 2003 and 2006