Elsevier

The Lancet

Volume 368, Issue 9541, 23–29 September 2006, Pages 1077-1087
The Lancet

Articles
Countdown to 2015: tracking donor assistance to maternal, newborn, and child health

https://doi.org/10.1016/S0140-6736(06)69338-0Get rights and content

Summary

Background

Timely reliable data on aid flows to maternal, newborn, and child health are essential for assessing the adequacy of current levels of funding, and to promote accountability among donors for attainment of the Millennium Development Goals (MDGs) for child and maternal health. We provide global estimates of official development assistance (ODA) to maternal, newborn, and child health in 2003 and 2004, drawing on data reported by high-income donor countries and aid agencies to the Organisation for Economic Development and Cooperation.

Methods

ODA was tracked on a project-by-project basis to 150 developing countries. We applied a standard definition of maternal, newborn, and child health across donors, and included not only funds specific to these areas, but also integrated health funds and disease-specific funds allocated on a proportional distribution basis, using appropriate factors.

Findings

Donor spending on activities related to maternal, newborn, and child health was estimated to be US$1990 million in 2004, representing just 2% of gross aid disbursements to developing countries. The 60 priority low-income countries that account for most child and newborn deaths received $1363 million, or $3·1 per child. Across recipient countries, there is a positive association between mortality and ODA per head, although at any given rate of mortality for children aged younger than 5 years or maternal mortality, there is significant variation in the amount of ODA per person received by developing countries.

Interpretation

The current level of ODA to maternal, newborn, and child health is inadequate to provide more than a small portion of the total resources needed to reach the MDGs for child and maternal health. If commitments are to be honoured, global aid flows will need to increase sharply during the next 5 years. The challenge will be to ensure a sufficient share of these new funds is channelled effectively towards the scaling up of key maternal, newborn, and child health interventions in high priority countries.

Introduction

Adequate financing is necessary for the scaling up of effective maternal, newborn, and child health interventions in order to achieve the Millennium Development Goals for child survival (MDG-4) and maternal health (MDG-5). Estimates place the additional funding requirements to attain universal coverage at a minimum of US$7000 million per year.1 Other estimates suggest that even greater investments are needed.2, 3 Irrespective of the precise figure, the conclusion is clear. The financing gap represents a substantial sum in relation to domestic budgets.

Despite a long history of attempts to track health expenditure in developing countries,4, 5 many data collection efforts,6 and various studies on a worldwide level,7, 8 little is known about how much is currently being invested in maternal, newborn, and child health by donors and within recipient countries, or whether levels of funding are changing. Timely, reliable data for health financial flows are essential for informed decision-making at both the worldwide and country level, and to address the gap between what is currently being invested and what is actually needed. For these reasons, tracking the financing flows is viewed as a crucial tool for the Partnership for Maternal, Newborn and Child Survival and others to advocate effectively for additional funds (www.pmnch.org). Monitoring the flow of aid also promotes accountability on the part of both donors and recipient countries in their joint commitment to meeting the MDG targets.

In this paper we estimate the amount of official development assistance (ODA) going to maternal, newborn, and child health in developing countries in 2003 and 2004 and assess broadly the adequacy of current levels in relation to the child and maternal health MDGs. These findings are part of a larger undertaking to monitor on a continuing basis the country-level progress in reducing child deaths, encapsulated in the Child Survival Countdown collaborative effort.9

Section snippets

Methods

Methods used were refined from those developed during an exploratory study to recommend an approach for tracking ODA to child health activities and provide preliminary estimates for a restricted number of donors. As part of the scope of work, we also explored the feasibility of tracking expenditure on child health at the country level.10 The present study included an expanded set of donors and broadened the expenditure boundaries to include maternal and neonatal health activities.

Results

In 2003 and 2004, $1997 million and $1990 million of ODA, respectively, went to activities related to maternal, newborn, and child health (table 2). In both years, child health accounted for more than two-thirds of total ODA to these areas, increasing its share from 67% in 2003 to 73% in the next year. Almost all funds to developing countries were provided as grants.

Bilateral donors were the main contributors of ODA to maternal, newborn, and child health, providing $1208 million, or 61% of

Discussion

The world's major donors gave an estimated $1990 million of aid to developing countries for maternal, newborn, and child health activities in 2004, of which $815 million was disbursed through projects exclusively targeting such activities. Funds for general health-care projects and for specific diseases accounted for a substantial 56% of total project funds. However, diarrhoea and pneumonia, the two diseases that kill the greatest number of children worldwide every year, are not addressed by

References (46)

  • RE Black et al.

    Where and why are 10 million children dying every year?

    Lancet

    (2003)
  • A Costello et al.

    The case for a new Global Fund for maternal, neonatal, and child survival

    Lancet

    (2005)
  • J Bryce et al.

    Can the world afford to save the lives of 6 million children each year?

    Lancet

    (2005)
  • Walker N, Bryce J, Lawn J, et al. A price tag for newborn and child survival. Conference on tracking progress in child...
  • Estimating the cost of scaling-up maternal and newborn health interventions to reach universal coverage: methodology and assumptions

    (2005)
  • Methodology and assumptions used to estimate the cost of scaling up selected child health interventions

    (2005)
  • B Abel-Smith

    Paying for health services: a study of the costs and sources of finance in six countries

    WHO Public Health Papers, 17

    (1963)
  • N Caiden et al.

    Planning and budgeting in poor countries

    (1974)
  • E Eiseman et al.

    The challenges of creating a global health resource tracking system

    (2005)
  • C Michaud et al.

    External assistance to the health sector in developing countries: a detailed analysis, 1972–90

    Bull World Health Organ

    (1994)
  • JP Poullier et al.

    Patterns of global health expenditures: results for 191 countries

  • J Bryce et al.

    Countdown to 2015: Tracking intervention coverage for child survival

    Lancet

    (2006)
  • T Powell-Jackson et al.

    Tracking official development assistance for child health, challenges and prospects

    (2006)
  • DAC List of ODA Recipients

    (2005)
  • V Narasimhan et al.

    Roll Back Malaria? The scarcity of international aid for malaria control

    Malaria Journal

    (2003)
  • Expert Group on Child Health Accounts. Minutes of Conference Call on Boundaries of Child Health Accounts. June 17,...
  • Reporting Directives for the Creditor Reporting System

    (2002)
  • M Foster et al.

    The choices of financial instruments. Working paper 158

    (2001)
  • Survey of the Alignment of Budget Support and Balance of Payments Support with National PRS Processes

    (2005)
  • Reporting Directives for the Creditor Reporting System—Addendum 2: Annex 5. Reporting on the Purpose of Aid

    (2005)
  • E Korenromp

    Malaria incidence estimates at country level for the year 2004—proposed estimates and draft report

    (2004)
  • EL Korenromp et al.

    Monitoring mosquito net coverage for malaria control in Africa: possession vs. use by children under 5 years

    Trop Med Int Health

    (2003)
  • 2004 Report on the Global HIV/AIDS Epidemic: 4th Global Report

    (2004)
  • Cited by (87)

    • 11 years of tracking aid to reproductive, maternal, newborn, and child health: estimates and analysis for 2003–13 from the Countdown to 2015

      2017, The Lancet Global Health
      Citation Excerpt :

      For general budget support, the rule was based on the proportion of government spending that goes to health and was obtained from the National Health Accounts database.6 The allocation of health systems funds and basket or sector funding to reproductive, maternal, newborn, and child health was the same for all countries, with estimates of spending related to reproductive, maternal, newborn, and child health based on the scientific literature.16 We reviewed and coded 231 398 disbursement records for the year 2013 across all sectors according to a previously developed framework.12,16

    View all citing articles on Scopus
    View full text