Amount of development aid to maternal, newborn and child health has doubled 2003-2008, but its ratio to overall aid to health remains static; US and UK lead way in donations

September 16, 2010

There has been a welcome doubling of the amount of official development assistance (ODA) to maternal, newborn, and child health (MNCH) over the 6 years from 2003 to 2008. But, since overall ODA to health has also doubled, the ratio of aid donated to MNCH has not changed and thus has received no additional priority relative to other health areas. The USA, UK, EU, GAVI, and the Global Fund have made the largest absolute increases, while Spain and a number of small bilateral donors including New Zealand and Belgium have made significant percentage increases, but support from many others has stagnated or fallen, and in some cases fluctuated significantly from year to year.These are among the findings of an Article published Online First to coincide with the Millennium Development Goal (MDG) special issue of The Lancet, written by Catherine Pitt, London School of Hygiene and Tropical Medicine, UK and colleagues.

The authors analysed aid flows for MNCH for 2007 and 2008 and updated previous estimates for 2003󈝲. They found that in 2007 and 2008, US$4•7 billion and $5•4 billion (constant 2008 US$), respectively, were disbursed in support of MNCH 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 (68 countries covering 97% of the global burden of maternal and child deaths) received $3•4 billion in 2007 and $4•1 billion in 2008, representing 71•6% and 75•6% of all MNCH disbursements, respectively. Targeting of ODA to countries with high rates of maternal and child mortality improved over the 6-year period, although some 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. Both these countries were already the biggest donors to this sector in 2003, and remained so in 2008, with USA more than tripling its 2003 contribution of $US260 million to $913 million, and the UK more than doubling what it gave in 2003 ($206 million) to £419 million in 2008.

The authors say: "The two leading bilateral donors consistently increased their aid between 2003 and 2008; however, reliance on just two bilateral donors for such a large proportion of funding risks exposing recipient countries to future volatility." Germany, Canada, Spain, and Norway also significantly increased their donations from 2003 levels. France saw its initially relatively small contribution drop, as did Australia.

Some recipient countries - like Djibouti and Equatorial Guinea - received far more aid per birth and per child than countries with lower incomes and higher mortality rates, while countries like Niger and Chad are losing out - they are amongst the poorest countries in the world and received far less aid per birth than many countries with higher incomes and better health. The authors also highlight the importance of how countries disburse the funds: Norway gives almost all its MNCH funds to the 68 countdown countries, whereas Japan directs much of its funds to non-Countdown nations where the need, though pressing, is not so great.

The authors say: "Despite signs that targeting might be improving, ODA was still not found to be highly targeted to countries with the highest rates of maternal and child mortality, which is consistent with findings from previous studies. Some countries persistently received far less ODA per head than did countries with much lower maternal and child mortality, and small, politically strategic countries received ODA that was disproportionate to their relative needs."

But they conclude: "The increases in ODA to maternal, newborn, and child health during 2003󈝴 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."

In a linked Comment, Dr Devi Sridhar, All Souls College, University of Oxford, UK, agrees that it is concerning that countries with large reserves and/or large defence spending (eg China, Brazil, India) are receiving valuable aid. She says: "To put it impolitely, why should aid dollars subsidise countries that can afford to independently provide health care?"

She concludes: "Pitt and colleagues present an important paper on financial flows for MNCH and should be commended for their careful and painstaking analysis, which included manual coding of OECD-CRS data. Their report leaves us with two further research steps that are central to better understand and improve the aid relationship. First, although Pitt and colleagues track ODA, this does not encompass total development assistance for health. For example, the Bill & Melinda Gates Foundation is not included in this analysis, nor are emerging donor states such as Brazil and China. It is unclear what percentage of total aid flows are captured through ODA, which means we simply do not know how much of the picture we are seeing. Second, we do not know the effect of this aid on improving health. Whilst money is of course central, our main interest is whether health outcomes for mothers, newborns, and children are improving. This has yet to be answered."
Catherine Pitt, London School of Hygiene and Tropical Medicine, UK. T) +44 (0) 7876 161888 E)

Dr Devi Sridhar, All Souls College, University of Oxford, UK. T) E)

For full Article and Comment see:



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