One of our key research interests at The Center for Policy Impact in Global Health is studying how money flows through the global health “system.” We are interested in questions such as where does global health financing come from, through which channels does it flow, where does it end up, and how is it used? There is an enormous financing gap to achieve the ambitious health-related Sustainable Development Goals (SDGs)—one study suggests that an additional $371 billion is needed annually across low- and middle-income countries—and the tracking of finance flows is critical in knowing whether the gap is being closed. Just meeting the child and maternal health targets in SDG3 alone is estimated to require an additional $33 billion annually.
In recent months, along with our colleagues at Open Consultants in Berlin, we have focused particularly on tracking official development assistance (ODA) and domestic financing for women’s, children’s, and adolescents’ health (WCAH). In this blog, I highlight some of the ways in which we have participated in the global discussions and debates on this tracking.
Comparing different tracking methods
Our Policy Associate Kaci Kennedy participated in a consultation held at the Gates Foundation office in London, co-hosted by the Partnership for Maternal, Newborn and Child Health (PMNCH) and Countdown to 2030, on ways to improve such tracking. Participants included representatives of donor governments, multilateral agencies, the research community, and the Development Co-operation Directorate of the Organisation for Economic Co-operation and Development (OECD).
When it comes to ODA, one big problem in trying to track flows to WCAH is that there are four different tracking methods, all of which have their defenders and critics—and all of which generate different results. These are Countdown to 2030’s method, the Institute for Health Metrics and Evaluation (IHME) approach, the G8’s Muskoka method, and the OECD reproductive, maternal, newborn and child health (RMNCH) policy marker. In a recent study, which was discussed at the London consultation, Catherine Pitt and colleagues compared the four approaches and found that “estimates of aid amounts and year-on-year trends differed substantially” between them, especially for individual donors and recipient countries. One outcome of the consultation was the formation of a new working group that will develop an improved method to track aid for WCAH, one based on “three Cs”: credibility in its methods; comprehensiveness in what it captures; and comparability (the ability to track aid across different donors and recipients).
Pitt and colleagues’ study was published in The Lancet Global Health. The journal commissioned me to write an accompanying commentary, which I co-authored with Kaci and our collaborator Marco Schäferhoff (Open Consultants). In our article, we conclude that, “any new method will need to grapple with the changing financing landscape in global health. One question is, how can a method link the tracking of aid for RMNCH with broader efforts to track funding for universal health coverage and domestic health spending?” To be timely and relevant, we also argue that any new tracking method “should capture aid from Brazil, China, India, and other emerging donors (none of the current methods do so).”
Image by PMNCH
Tracking commitments to the Every Woman, Every Child Global Strategy
Kaci and I also collaborated with Open Consultants on a new analysis, commissioned by PMNCH, of commitments that were made to advance the Every Woman, Every Child (EWEC) Global Strategy. This strategy, which was updated in 2015, provides a “roadmap for ending all preventable maternal, newborn and child deaths, including stillbirths, by 2030, and improving their overall health and wellbeing.” Countries of any income group, as well as a variety of organizations (including businesses and NGOs), make financial commitments to support the strategy, and our analysis fed into a new report that tracks commitments made from September 2015 to December 2017.
Our analysis found that:
- Financial commitments pledged to the Global Strategy are now over US$35 billion
- Commitments in 2017 were up by 40% from 2016
- The July 2017 Family Planning Summit held in London, which launched the Family Planning 2020 movement, was a major factor driving increased commitments: 83% of all 2017 commitments were made via this summit
- Adolescents received significantly more attention in 2017 commitments compared to the first two years of the updated EWEC Global Strategy (i.e. 2015 and 2016). This increased attention was largely due to the 2017 Family Planning Summit commitments that supported the reduction of adolescent mortality and the adolescent birth rate.
- Financial commitments towards reducing newborn mortality and stillbirth rates still require a stronger focus. Commitments that focused on reducing the neonatal mortality fell behind those in support of reducing the maternal mortality ratio and the adolescent and under-5 mortality rates. Only 5% of financial commitments made from September 2015 to December 2017 were to reduce the stillbirth rate.
- Only about a quarter of all commitments during this time period supported women, children and adolescents in humanitarian settings.
A conversation on financial accountability at the UN General Assembly
Finally, I had the privilege of being a panelist during the PMNCH “Annual Accountability Breakfast” held during the UN General Assembly meeting in New York in September, 2018, which was chaired by Michelle Bachelet, PMNCH Board Chair and former President of Chile.
As the name suggests, the purpose of this event was to highlight three different aspects of accountability for reaching the RMNCH targets in the SDGs:
- The first panel focused on performance accountability. It highlighted areas of poor or worsening performance, such as on neonatal mortality and on improving the health of women and children in humanitarian settings.
- The second panel, which I was on, focused on financial accountability. We discussed the most promising ways to close the annual $33 billion RMNCH finance gap, and had a lively and sometimes contentious debate on the role of so-called innovative financing approaches and of the private sector.
- The final panel examined social and political accountability, including the role of the media. It was fantastic to hear from our Duke colleague, author and journalist Jonathan Katz, who broke the story that the United Nations likely caused and covered up its role in the deadly cholera epidemic in Haiti that followed the January 2010 earthquake.
Conclusion: the stakes are high
The Center for Policy Impact in Global Health believes that it is critical to “follow the money” because the stakes are so high. In a recent BMJ analysis that we co-authored, we found that 42 countries are not on track to reach both the child and maternal mortality targets in SDG3, and a further 37 countries will miss at least one of these. Closing the annual RMNCH financing gap is literally a matter of life and death for millions of mothers and children—and proper tracking of financing for RMNCH is an essential tool in reaching the maternal and child health SDG targets.
Gavin Yamey, Director of the Center for Policy Impact in Global Health and Professor of Global Health – Duke Global Health Institute, Duke University