In this GP Response, Flavia Bustreo and Jane Thomason review 'Financing Global Health 2013: Transition in an Age of Austerity'.
Despite gloomy predictions and a period of global donor “belt tightening”, the latest Institute for Health Metrics and Evaluation IHME report, 'Financing Global Health 2013 Financing Global Health 2013: Transition in an Age of Austerity' brings better news than many expected. Development Assistance for Health (DAH) remained steady, with a 3.9% growth from 2012 to 2013.
The report confirms, as many have been predicting, important shifts in the sources of DAH. Bilateral aid agencies share of DAH has diminished, contributions from World Bank’s International Bank for Reconstruction have peaked, philanthropy has increased, major public private partnerships (GAVI and the Global Fund) continued to expand, and growth in DAH from non-governmental organizations (NGOs), has also helped offset declines in spending by others. Domestic spending by governments dwarf DAH - countries spent 20 times more of their own resources on health than they received in assistance, and government health spending grew at a faster pace than DAH.
Maternal Neonatal and Child Health (MNCH) has been a big winner in the 2013 report. DAH for MNCH grew substantially by 17.7% from 2010 to 2011, reaching $6.1 billion in 2011. This is good news, however, there is no time for complacency.
Looking more closely at the figures, there remains an imbalance between development spending and burden of disease measured by Disability Adjusted Life Years (DALYs). South Asia and Sub Saharan Africa receive some of the lowest DAH for MNCH per DALY, and alarmingly, the rate has grown driven by increased DALYs rather than a lack of spending. The largest low and middle income countries China, India, Indonesia, Nigeria and Pakistan continue to lead the list of MNCH DALYs and over 35 countries received less than $5.00 in DAH per MNCH DALY. The world is not keeping up. Despite the expansion in funds much of the MNCH burden remains unaddressed.
Notably, the MNCH windfall is largely representative of significant scale up of funding from two donors, the UK and Bill and Melinda Gates Foundation (BMGF) which were the primary sources of the increase. In 2010 UK bilateral assistance was $ 88 million and it rose to $ 238 million in 2011 a 171% rise and BMGF increased by 119% or $366 million. While good news for now, simply stated - a change of policy in Britain or a change of heart by BMGF could significantly curtail future progress.
The report documents the increased expenditure for MNCH, but it does not explain it. The scale up was not a random piece of good luck. It was the result of a sustained political and advocacy campaign following the launch of the UN Secretary-General’s Global Strategy for Women’s and Children’s Health in 2010 and the Muskoka initiative on MNCH, also in 2010, which committed member nations to collectively spend an additional $5 billion between 2010 and 2015 to accelerate progress toward the achievement of MDGs 4 and 5. The Every Woman Every Child platform, increasingly hailed as a model for multi-stakeholder, innovative and transformative partnerships, has been able to mobilize and intensify global action to save and improve the lives of 16 million of women and children around the world and to raise significant resources. Commitment-makers include 62 low- and middle-income countries, 43 private sector companies, 24 foundations and 17 donor countries, and nearly 80 NGOs, among other institutions and partnerships.
Political mobilisation has been key and the IHME report does highlight the role of global events to catalyse additional funding. The London Family Planning Summit raised commitments of more than $4.6 billion in 2012 and at the Global Vaccine summit in 2013 donors pledged 4 billion. This again, a testament to the value of sustained advocacy to catalyse high level political engagement, leading to sustained action.
Advocacy and events can raise commitments, but what makes commitment makers accountable? Central to the sustained focus on women’s and children’s health has been the establishment of an accountability platform following the UN Commission on Information and Accountability for Women’s and Children’s Health. Scrutinised by an independent Expert review Group, the accountability work has established the foundation for transparency and accountability for the resources commitment makers invest, and monitoring the progress achieved in countries.
As part of the accountability work, the OECD DAC Working Party on development Finance Statistics has completed the reporting guideline for an RNMCH scoring system/marker – so through OECD at least, we will be able to routinely track RNMCH expenditure. To be truly effective, the accountability work also requires accurate statistics on child and maternal mortality. As the numbers of maternal and child deaths decline, it becomes increasingly important to be able to identify and track the most marginalized and impoverished populations where mortality is highest. This cannot be accomplished without improving country systems to reliably track and measure births, deaths and causes of death.
Healthy and prosperous economies start with healthy children born to healthy women. The world is reducing child deaths faster than at any other time during the past two decades, with 17,000 fewer children dying each day in 2012 than did in 1990. The number of women who die each year from pregnancy and childbirth has dropped by 47% from 1990-2010. Half of all HIV reductions in the last two years have been among newborn children – showing that a generation free of AIDS is possible. Vaccine coverage is greater than ever before with 4 out of 5 children receiving life-saving vaccines.
There remains an unfinished agenda for improving women’s and children’s health.We are now, for the first time, envisaging a world where it is possible to avoid the loss of every woman and every child due to preventable causes.
The IHME report is welcome and the news it brings is extremely encouraging. The first challenge for the MNCH community is to understand its success. Work must then begin to sustain and increase these levels of commitment to MNCH, especially with the MDG deadline approaching and the risk of dwindling interest in MNCH, as world attention moves on to a new sustainable development agenda post 2015.
Dr. Flavia Bustreo is Assistant Director General, Family and Women’s Health, World Health Organization. Dr Jane Thomason, is an Adviser to WHO, Family and Women’s Health and CEO of AbtJTA. This post is part of our GP Responses initiative.