Donor aid from governments and global agencies to support maternal, newborn and child health increased substantially between 2003 and 2009, but, for the first time, dipped slightly in 2010, a recent analysis suggests.1 Disbursements more than doubled, from $2.6 billion to $6.5 billion (in constant 2010 U.S. dollars), over the eight-year period, representing an average increase of 15% per year; in 2010, however, aid declined by 0.5%. Levels of aid to specific countries were more positively associated with levels of maternal and child mortality in 2010 than in 2005, suggesting that donor expenditures are being better allocated according to degree of need.
To assess trends in levels and targeting of donor aid, researchers used data from the Organisation for Economic Co-operation and Development’s Creditor Reporting System to track disbursements from 2003 to 2010 from 43 donors, including 25 countries, 16 multilateral agencies (e.g., the World Health Organization) and two global health initiatives (e.g., the Global Fund). Donor aid was included in the analysis if its main purpose was to restore, improve and maintain maternal and newborn health (i.e., during pregnancy, childbirth and the first seven days postpartum) or child health (from the age of one week to age 5).
To assess the extent to which donor aid is targeted to health needs, the investigators examined the association between maternal and child mortality rates in 74 priority countries (i.e., those that account for the vast majority of maternal and child deaths) and levels of aid to those countries. This analysis was limited to a consistent set of 31 donors for whom disbursement data was regularly available from 2003 to 2010. All aid amounts were converted into 2010 U.S. dollars to allow for comparisons across time.
Between 2003 and 2010, annual donor assistance for maternal, newborn and child health increased from $2.6 billion to $6.5 billion, which translates to an average annual increase of 15%. In most years, expenditures increased substantially from the previous year. From 2005 through 2009, aid levels increased by at least 8%, and by as much as 37%, per year; rates of increase were generally similar for aid to the 74 priority countries. However, in 2010, donor assistance declined for the first time, albeit by a small degree (less than 1%), among all countries, and increased by only 3% among the priority countries. In comparison, global aid (excluding debt forgiveness) for all purposes increased by 5%, and that for all health programs by 8%, in 2010.
During 2003–2010, expenditures on child health accounted for about two-thirds of donor aid for maternal, newborn and child health programs, and about three-quarters of aid went to the priority countries. Not surprisingly, populous countries tended to receive the most aid; in 2010, for example, India, Pakistan, Tanzania, Nigeria and the Democratic Republic of the Congo received 27% of aid to priority countries for maternal, newborn and child health.
In 2010, the median aid to priority countries for child health programs was $17.90 per child, and the median aid for maternal and newborn health was $29.40 per live birth; these amounts are, respectively, 4.0 and 2.5 times those in 2003 in real terms. Regression models that compared levels of aid with mortality rates revealed that in both 2005 and 2010, disbursement of aid for child health programs was greater to countries with higher levels of child mortality. Disbursement for maternal and newborn health was unrelated to maternal mortality levels in 2005 but positively associated with maternal mortality in 2010, suggesting that targeting of funds improved. However, the regression coefficients were low in both analyses, suggesting room for improvement in responsiveness to need.
The investigators noted some limitations of their study. The analysis did not include support from nonprofit organizations, or aid from governments (including Brazil, China, India, Russia and South Africa) that do not report to the Creditor Reporting System (these countries provide about 10% of global aid). Moreover, the analysis provides only a portion of the financing picture, as domestic expenditures, which represent three-quarters of health spending in low-income countries, were not included in the analyses, because methods and tools for collecting and tracking such data are not yet fully developed.
Although the findings indicate that donor aid for maternal, newborn and child health more than doubled between 2003 and 2009, the results—together with recent reports from governments and global organizations—also suggest that aid decreased slightly in 2010, probably at least in part because of the present financial crisis, the researchers note. This reality underscores the need to improve the efficiency, effectiveness and targeting of aid, and to ensure donor accountability, the investigators emphasize. “Now, more than ever, independent monitoring and analysis of the quantity and quality of official development assistance is necessary to assess donor accountability and to understand and mitigate the potential effect of the present economic conditions on funding for maternal, newborn and child health.”—P. Doskoch
1. Hsu J et al., Countdown to 2015: changes in official development assistance to maternal, newborn, and child health in 2009–10, and assessment of progress since 2003, Lancet, 2012, 380(9848):1157–1168.