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Donor funding for reproductive, maternal, newborn and child health nears us$14 billion annually.

Donor development aid for reproductive, maternal, newborn and child health worldwide more than tripled between 2003 and 2013, although it is unknown whether this marked increase translated into better outcomes, according to an analysis from the Countdown to 2015 project. (1) The amount of official development assistance funds plus grants from the Bill & Melinda Gates Foundation (collectively termed ODA+) to these health subsectors increased by 225% over the period--to nearly US$14 billion. Gains were greatest for child health, with the bulk going to immunization efforts, and for reproductive and sexual health, with the bulk going to HIV interventions. Correlation between amounts disbursed and country metrics of health need became stronger over the study period, a change that suggests better targeting of funding to level of need.

For the study, investigators used the January 2015 download from the creditor reporting system of the Organisation for Economic Co-operation and Development, which included global financial disbursements through 2013. They used a predefined framework to code all projects over the 2003-2013 period on the basis of whether they were related to reproductive, maternal, newborn and child health; they also coded disbursements for 2003-2008 relating to reproductive and sexual health activities. The end result was a Countdown data set for 2003-2013, which was matched to the 2015 creditor reporting system data set. The investigators then analyzed trends in ODA+ for reproductive, maternal, newborn and child health for 2003-2013, trends in donor contributions and disbursements to recipient countries. They also calculated Spearman correlation coefficients between funds disbursed and selected metrics of health need to assess targeting.

In 2013, a total of 147 countries and 17 regional entities received ODA+ disbursements. These disbursements were made by 64 donors reporting to the creditor reporting system and the Bill & Melinda Gates Foundation. Results of analyses show that ODA+ to the entire health sector in 2013 amounted to US$24 billion, or 15% of the total for that year--an increase from 10% in 2003. Disbursements specifically for reproductive, maternal, newborn and child health in 2013 amounted to almost US$14 billion. Some 48% of this amount--$6.8 billion-supported child health, 34% ($4.7 billion) supported reproductive and sexual health, and 18% ($2.5 billion) supported maternal and newborn health. Between 2003 and 2013, ODA+ for reproductive, maternal, newborn and child health increased by 225% overall; the increase was greatest for child health (286%), followed by reproductive and sexual health (194%) and maternal and newborn health (164%).

Bilateral donors accounted for the largest share--59%--of all ODA+ for reproductive, maternal, newborn and child health in 2013; global health initiatives disbursed 23%, and multilateral aid agencies disbursed 13%. The leading donors for the period 2003-2013 were the United States (US$32 billion), the Global Fund (US$11 billion), the United Kingdom (US$7.3 billion) and the Global Alliance for Vaccines and Immunization (US$6.6 billion); these same donors were also the leaders in 2013.

Throughout the study period, most ODA+ for reproductive, maternal, newborn and child health was concentrated in the 75 Countdown priority countries, where 95% of all maternal and child deaths occur. In addition, compared with nonpriority countries, priority countries had much greater growth in ODA+ for reproductive and sexual health (205% vs. 90%), child health (305% vs. 128%), and maternal and newborn health (190% vs. 31%) over the 2003-2013 period. Among the priority countries, the largest total disbursements for reproductive, maternal, newborn and child health in 2013 were to Nigeria, Ethiopia and Kenya, and the smallest were to Equatorial Guinea, Turkmenistan and Gabon. Between 2003 and 2013, Somalia and Nigeria saw the greatest relative increases (878% and 768%, respectively), and Equatorial Guinea and Brazil saw the greatest relative decreases (-80% and -74%, respectively).

Targeting of ODA+ for reproductive, maternal, newborn and child health to countries with the greatest need in these areas appears to have improved over the study period. For example, the correlation coefficient between the amount of ODA+ for child health for each child younger than five and the country's mortality rate for children in that age-group increased from 0.31 to 0.45. Similarly, the correlation coefficient between ODA+ for reproductive and sexual health per woman aged 15-49 and the country's HIV prevalence increased from 0.48 to 0.61.

In the 75 priority countries, 99% of ODA+ for reproductive, maternal, newborn and child health in 2013 was channeled as projects, with the remainder channeled through general or sectoral budget support, or through pooled funding mechanisms. The largest share of project funding was for HIV (28%), followed by immunization (18%), reproductive health funds (15%) and the general health care system (13%). Between 2003 and 2013, relative increases in funding were greatest for malaria and HIV-related activities; the largest amount of aid for that period went to HIV (US$2.9 billion), health care systems (US$ 1.6 billion), and reproductive health and immunization (US$1.3 billion each).

The analysis extends previous Countdown efforts to track the flow of aid, which helps to promote donor accountability and to assess matching of resources to need, according to the investigators. It was limited by its reliance on manual coding and donors' descriptions of projects, possible inaccuracies in categorizing disbursements and its limitation to external sources of funding, which would not capture domestic investments and out-of-pocket expenditures, they acknowledge. "The sustained increase in reproductive, maternal, newborn, and child health funding over the period 2003-2013, and possible improved targeting to need, is encouraging. However, substantial unexplained variation between countries remains and further research is needed to assess whether these increases are effective in improving health outcomes," the investigators conclude.


(1.) Grollman C et at, 11 years of tracking aid to reproductive, maternal, newborn, and child health: estimates and analysis for 2003-13 from the Countdown to 2015, Lancet Global Health, 2017, 5(1):e104-e114.
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Title Annotation:DIGEST
Author:London, S.
Publication:International Perspectives on Sexual and Reproductive Health
Date:Dec 1, 2016
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