Countdown to 2015: assessment of official development assistance to maternal, newborn, and child health, 2003–08

Summary

Background

Achievement of high coverage of effective interventions and Millennium Development Goals (MDGs) 4 and 5A requires adequate financing. Many of the 68 priority countries in the Countdown to 2015 Initiative are dependent on official development assistance (ODA). We analysed aid flows for maternal, newborn, and child health for 2007 and 2008 and updated previous estimates for 2003–06.

Methods

We manually coded and analysed the complete aid activities database of the Organisation for Economic Co-operation and Development for 2007 and 2008 with methods that we previously developed to track ODA. By use of newly available data for donor disbursement and population estimates, we revised data for 2003–06. We analysed the degree to which donors target their ODA to recipients with the greatest maternal and child health needs and examined trends over the 6 years.

Findings

In 2007 and 2008, US$4·7 billion and $5·4 billion (constant 2008 US$), respectively, were disbursed in support of maternal, newborn, and child health activities in all developing countries. These amounts reflect a 105% increase between 2003 and 2008, but no change relative to overall ODA for health, which also increased by 105%. Countdown priority countries received $3·4 billion in 2007 and $4·1 billion in 2008, representing 71·6% and 75·6% of all maternal, newborn, and child health disbursements, respectively. Targeting of ODA to countries with high rates of maternal and child mortality improved over the 6-year period, although some of these countries persistently received far less ODA per head than did countries with much lower mortality rates and higher income levels. Funding from the GAVI Alliance and the Global Fund to Fight AIDS, Tuberculosis and Malaria exceeded core funding from multilateral institutions, and bilateral funding also increased substantially between 2003 and 2008, especially from the USA and the UK.

Interpretation

The increases in ODA to maternal, newborn, and child health during 2003–08 are to be welcomed, as is the somewhat improved targeting of ODA to countries with greater needs. Nonetheless, these increases do not reflect increased prioritisation relative to other health areas.

Funding

Partnership for Maternal, Newborn, and Child Health on behalf of the Countdown to 2015 Initiative.

Introduction

Despite some notable success stories, many countries are faltering in their efforts to achieve the Millennium Development Goals (MDGs) for child and maternal health.¹ The Countdown to 2015 Initiative, which tracks the progress of 68 priority countries, recently announced that only 19 countries are on track to achieve MDG 4 (to reduce child mortality by two-thirds) and even fewer are on track for MDG 5A (to reduce the maternal mortality ratio by three-quarters).² In many of the countries failing to make progress, essential health interventions with proven effectiveness, such as postnatal care and insecticide-treated bednets, reach less than one-third of those in need of them.² Although the reasons for this failing are complex, lack of financing is often a key factor.

Internally generated financing accounts for more than 85% of total health expenditure on average across the 68 priority countries;3, 4 however, external donors have a potentially important part in expanding coverage of health interventions and improving health. The health budgets of governments in low-income countries are often greatly tied up in expenditures on salaries⁵ and hospitals, making reallocation politically difficult.⁶ Donor contributions are much greater relative to health budgets in countries with the highest levels of maternal and child mortality and provide a key source of discretionary financing that can be used strategically to implement new health programmes.

In recent years, there have been calls for substantial increases in both the quality and quantity of donor funding. The Paris Declaration on Aid Effectiveness and the Accra Agenda for Action were motivated by concerns that official development assistance (ODA) could and should be better spent.7, 8 These agreements stressed the need for more predictable financing in the form of grants rather than loans, increased channelling of aid through recipient country budgets, and better coordination between donors. International advocacy in relation to maternal, newborn, and child health has expanded enormously as the MDG deadline draws near, and there is an expectation that these efforts should lead to increased ODA flows to countries most in need.

Independent and timely examination of ODA flows from donors for maternal, newborn, and child health is crucial for tracking progress and holding donors to account. Several recent reports have provided estimates and analysis of aid flows to the health sector as a whole in developing countries,9, 10, 11, 12 as well as to specific sub-sectors and groups of countries, such as reproductive health in countries affected by conflict.¹³ Only two studies, however, have provided estimates specific to MDGs 4 and 5A. Powell-Jackson and others¹⁴ and Greco and others¹⁵ provided estimates of ODA to maternal and newborn health and to child health for the years 2003–06.

This report provides estimates for 2007 and 2008, and revises previous estimates for 2003–06 by use of newly available expenditure data for donors who did not report disbursements in previous years (eg, the World Bank) and updated population estimates. Additionally, this analysis looks in greater detail at ODA contributions to the 68 Countdown priority countries and assesses the degree to which ODA for maternal, newborn, and child health is targeted towards countries with the greatest needs.