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