Maternal and child health MDGs: The neglected priorities?

Rationale: Slow improvements, and even reversals, in health status of the population in many developing countries, particularly in Sub-Saharan Africa, galvanized the international community to renew its efforts to combat specific diseases and reduce the burden associated with the principal causes of morbidity and mortality among the world's poor. The Millennium Development Declaration set specific targets for reducing maternal mortality, mortality in children under five, and reversing the spread of HIV/AIDS and the incidence of malaria. Many new global initiatives aimed at improving the response to specific illnesses were formed and unprecedented levels of funding are now flowing through these mechanisms

Objectives: To estimate the flow of funds to priority areas identified in the Millennium Development Goals (MDGs) and, particularly, to reproductive and child health.

Methods: The international classification of health accounts is adapted to track the flow of funds for HIV/AIDS, maternal, child and reproductive health services. The origins of funds are identified as well as allocation to specific program and service delivery components of interest to global and bilateral initiatives, and national strategic plans. Estimates of spending by program/ treatment categories are presented for 6 countries from 2002-2005.

Results: While funding for health has increased uniformly in all the countries studied (Rwanda, Ethiopia, Malawi, Kenya, Jordan and Ukraine), certain priority areas have benefited from large funding increases while others have not. Reproductive and child health have seen relatively modest gains despite the heavy burden associated with maternal and child morbidity and mortality. In most cases, funds were not allocated according to the spending priorities established in national strategic plans. Further, though the principal of additionality has been met in many countries growth in government spending remain relatively small.

Conclusions: As health funds increasingly flow from external sources to NGOs, the ability of government to exercise stewardship over prevention and care is challenged. As demonstrated by the experiences of the governments of Ethiopia, Kenya, Malawi, and Rwanda, developing systems to track the flow of resources against program objectives can be a powerful tool in guiding health policy design to achieve the MDGs.