Annex 2
DISTRIBUTION OF DFID'S FINANCIAL RESOURCES
ACROSS A MIX OF AID INSTRUMENTS; AND METHOD FOR TRACKING MATERNAL
HEALTH SPEND
DFID employs a range of aid instruments to support
maternal health
The choice and mix of aid instruments is made
according to the country context. This range of flexible financing
mechanisms is important in delivering different objectives. For
example, support through non-state channels is likely to be needed
if the aim is to address "sensitive" issues such as
preventing unsafe abortion or addressing female genital mutilation73,
or where funds are provided to support civil society or the media
hold the government to account on delivering health services.
On the other hand, budget support to national
governments enables DFID to invest in a predictable way in a number
of sectors (health, water, education) that have an impact on maternal
health. It also helps us to provide long term investment in health
systems, which as described above, are central to DFID's approach
to improving maternal health. However, as discussed above, general
budget support makes tracing DFID investment in maternal health
and its impact complex.
How DFID measures its financial support for maternal
and newborn health
DFID measures maternal health spending by marking
new projects and programmes with a maternal and newborn health
or reproductive health sector code, which allows us to track spending
over time and across different programmes. Sector budget support
that is aimed solely at these issues will also be counted in the
same way.
But there are three important channels where
the picture grows more complex: (a) the multilaterals, (b) general
budget support and (c) sector budget support that aims to strengthen
health systems. Each of these contributions will help to improve
service delivery for the health sector, and create spillover benefits
for maternal health; but it is not possible to identify how much
they directly benefit maternal health programmes within partner
countries.
DFID does not earmark for sub-sectors such as
maternal health, so we can only estimate how much of our multilateral
spending targets maternal and newborn health. The same can be
said of general budget support, which is provided directly to
national governments, who make the sectoral allocations. The allocation
of general budget support towards the health sector is derived
from the proportion of national spending on health as a share
of the entire national budget. It is not possible to say how much
of national spending, and therefore our general budget support,
was spent on health sub-sectors.
The share of general budget support provided
to Africa since 2002 that can be attributed to health is approximately
£171 million. Similarly, sector budget support for wider
health systems amounted to an additional £48 million for
Africa, which will have contributed towards our maternal health
goals as well. As such, the figures do not represent the entirety
of DFID's expenditure, and should be used with caution.
As discussed above, the distinctions between
the health sub-sectors places an artificial distinction amongst
the interventions. A process is underway to bring DFID's statistical
monitoring systems in line with the OECD, which promises to improve
our capacity to track spending.
Further information
DFID's Maternal Health Strategy. Reducing maternal
deaths:. evidence and action. Second Progress Report. Report by
the Department for International Development, April 2007—http://www.dfid.gov.uk/pubs/files/maternal-health-progress-report.pdf
REFERENCES
1 WHO (2005) Facts and figures from the World
Health Report 2005—Make every mother and child count, Geneva
2005 http://www.who.int/whr/2005/media_centre/facts_en.pdf
2 WHO (2004) Maternal Mortality in 2000—Estimates
developed by WHO, UNICEF and UNFPA, WHO Geneva http://www.who.int/reproductive-health/publications/maternal_mortality_2000/
3 WHO (2004) Maternal Mortality in 2000—Estimates
developed by WHO, UNICEF and UNFPA, WHO Geneva http://www.who.int/reproductive-health/publications/maternal_mortality_2000/
4 WHO (2005) Facts and figures from the World
Health Report 2005—Make every mother and child count, Geneva
2005 http://www.who.int/whr/2005/media_centre/facts_en.pdf
5 WHO analysis of causes of maternal death: a
systematic review Khan. K.S., Wojdyla, D, Say, L, Gulmezoglu,
A M and Van Look, P F A. The Lancet 2006 367 pp 1066-74
6 WHO, UNICEF, UNFPA: Maternal Mortality Estimates
in 2000 (2004) p25 and p26
7 WHO (2004) Maternal Mortality in 2000—Estimates
developed by WHO, UNICEF and UNFPA, WHO Geneva http://www.who.int/reproductive-health/publications/maternal_mortality_2000/
8 WHO (2005) World Health Report 2005—Make
every mother and child count, Geneva http://www.who.int/whr/2005/en/
9 ID21 (2007) Improving the health of mothers
and babies, ID21 Insights Health 11, International Development
School, University of Sussex, UK http://www.id21.org/health/InsightsHealth11art3.html
10 Lawn, J, Cousens, S and Zupan, J (2005) Four
million neonatal deaths: When?, Where?, Why? Lancet Neonatal Series
11 Koblinsky, Matthews et al (2006) Going to
scale with professional skilled care, Lancet Maternal Survival
Series www.womendeliver.org/pdf/Maternal_Lancet_series.pdf
12 The Partnership for Maternal, Newborn and
Child Health, The continuum of care- facts, PMNCH, 2005, Geneva
13 WHO (2005) World Health Report 2005—Make
every mother and child count, Geneva
http://www.who.int/whr/2005/en/
14 United Nations (2007) The Millennium Development
Goals Report 2007, New York
http://www.un.org/millenniumgoals/pdf/mdg2007.pdf
15 WHO (2006) World Health Report 2006—Working
Together for Health
16 Ronsmans, C, Graham, W J (2006) Maternal mortality:
Who, when, where and why?, The Lancet, Volume 368, Issue 9542,
Pages 1189-1200 http://www.womendeliver.org/pdf/Maternal_Lancet_series.pdf
17 Graham WJ, Fitzmaurice AE, Bell JS, Cairns
JA. 2004. The familial technique for linking maternal death with
poverty Lancet, 363:23-27
18 Sein,T. and Rafai,U.M. (2002) No more cradles
in the graveyard , Regional Health forum SEARO, Vol 6, no 2, Geneva
http://www.searo.who.int/en/Section1243/Section1310/Section1343/Section1344/Section1356_5326.htm
19 Falkingham, J. (2007) The impact of maternal health
on poverty, ID21 Insights Health 11, International Development
School, University of Sussex http://www.id21.org/health/InsightsHealth11art3.html
20 Lawn, J, Cousens, S, and Zupan, J. (2005)
four million neonatal deaths: When? Where? Why?, The Lancet 365:
pp 891-900 www.thelancet.com/collections/series/neonatal
21 Ronsmans, C, Graham, W J (2006) Maternal mortality:
Who, when, where and why?, The Lancet, Volume 368, Issue 9542,
Pages 1189-1200 http://www.womendeliver.org/pdf/Maternal_Lancet_series.pdf
22 In 2007, DFID updated its Health Strategy
Working together for better health, and the four pillars of this
strategy will contribute significantly to better maternal health
services: delivering more resources for health; expanding access
to basic services; improving the effectiveness of international
funding for health; and demonstrating results and building evidence
of what works.
23 WHO (2005) World Health Report 2005—Make
every mother and child count, Geneva
http://www.who.int/whr/2005/en/
24 40% of all childhood deaths occur in the first
four weeks of life, so providing skilled newborn care is an essential
part of the action needed to reach MDG 4.
25 Studies are ongoing in Nepal and Bangladesh
to determine the extent of these success factors.
26 Evacuation of the uterus of a woman who has
missed her menstrual period by 14 days or fewer, who previously
had regular periods and who has been at risk of conception. It
may be performed before proof of pregnancy. (IPPF Glossary of
sexual and reproductive health terms)
http://glossary.ippf.org/GlossaryBrowser.aspx
27 Ronsmans, C, Graham, W J (2006) Maternal mortality:
Who, when, where and why?, The Lancet, Volume 368, Issue 9542,
Pages 1189-1200 http://www.womendeliver.org/pdf/Maternal_Lancet_series.pdf
28 Nepal Ministry of Health (1998) Kathmandu
29 Shiffman, J. (2007) Generating political priority
for maternal mortality reduction in five developing countries
American Journal of Public Health, 97, pp 796-803
30 Matthews, Z. (2007) Improving the health of
mothers and babies—Breaking through health system constraints,
ID21 insights health 11, International Development School, University
of Sussex
http://www.id21.org/insights/insights-h11/index.html
31 Ronsmans, C, Graham, W J (2006) Maternal mortality:
Who, when, where and why?, The Lancet, Volume 368, Issue 9542,
Pages 1189-1200 http://www.womendeliver.org/pdf/Maternal_Lancet_series.pdf
32 Cost effectiveness analysis of strategies
for maternal and neonatal health in developing countries (2005)
Adam, T, Lim, S L, Mehta, S, Bhutta, Z A, Fogstad, H, Mathai,
M, Zupan, J and Darmstadt, G. British Medical Journal 331 pp 1107-1115
33 World Health Organization, (2001) Advancing
Safe Motherhood through Human Rights
http://www.who.int/reproductive-health/publications/RHR_01_5_advancing_safe_motherhood/RHR_01_05_table_of_contents_en.html
34 WHO (2005) World Health Report 2005—Make
every mother and child count, Geneva
http://www.who.int/whr/2005/en/
35 Padmanathan, I, Liljestrand, J and Martins,
J M (2003) Investing in Maternal Health in Malaysia and Sri Lanka
World Bank Health, Nutrition and Population Series http://web.worldbank.org/WBSITE/EXTERNAL/TOPICS/EXTHEALTHNUTRITIONANDPOPULATION
36 Koblinsky, M (2003) Reducing Maternal Mortality
: Learning from Bolivia, China, Egypt, Honduras, Indonesia, Jamaica,
and Zimbabwe World Bank Health, Nutrition and Population Series
http://web.worldbank.org/WBSITE/EXTERNAL/TOPICS/EXTHEALTHNUTRITIONANDPOPULATION
37 DFID works in 150 countries through its support
to the multilateral system, and has 64 country offices. Most aid
is provided to 26 countries (16 countries in Africa and nine in
Asia). Africa: DRC, Ethiopia, Ghana, Kenya, Lesotho, Malawi, Mozambique,
Sierra Leone, South Africa, Nigeria, Rwanda, Sudan, Tanzania,
Uganda, Zambia, Zimbabwe; Asia: Afghanistan, Bangladesh, Cambodia,
India, Indonesia, Nepal, Pakistan and Vietnam; and Middle East:
Yemen.
38 DFID does not earmark our funding to the multilateral
in this way.
39 Global estimates on maternal mortality will
be released by WHO in October 2007, at which time a better picture
of maternal mortality trends will emerge. However, poor data is
a real constraint to measuring progress accurately.
40 WHO (2004) Maternal Mortality in 2000—Estimates
developed by WHO, UNICEF and UNFPA, WHO Geneva http://www.who.int/reproductive-health/publications/maternal_
mortality_2000/
41 World Health Organization. World health report
2005: make every mother and child count. Principal authors: Wim
Van Lerberghe, Annick Manuel, Zoe Matthews and Cathy Wolfheim.
Geneva, Switzerland, 2005 page 68, http://www.who.int/whr/2005/en/
42 World Health Organization, UNICEF, UNFPA,
Maternal Mortality in 2000: Estimates developed by WHO, UNICEF
and UNFPA
http://www.who.int/reproductive-health/publications/maternal_mortality_2000/
43 Hill, K, Abouzahr, C and Wardlaw, (2001) T.
Estimates of maternal mortality for 1995, Bulletin of the world
Health Organisation, Volume 79 (3) http://www.who.int/bulletin/archives/79(3)182.pdf
44 World Health Organization. World health report
2005: make every mother and child count. Principal authors: Wim
Van Lerberghe, Annick Manuel, Zoe Matthews and Cathy Wolfheim.
Geneva, Switzerland, 2005, http://www.who.int/whr/2005/en/
45 Matthews, Z, Manuel, A, Fogstad, H and Van
Lerberghe, W. Chapter 8: Evaluating and monitoring skilled care
. In Ten Hoope Bender, P. and Starrs, A. (eds), Skilled Care—A
Review, Partnership for Safe Motherhood and Newborn Health. Geneva
46 United Nations, The Millennium Development
Goals Report 2007, UN
http://www.un.org/millenniumgoals/pdf/mdg2007.pdf
47 United Nations, The Millennium Development
Goals Report 2007, UN
http://www.un.org/millenniumgoals/pdf/mdg2007.pdf
48 Ronsmans, C, Graham, W, Maternal Mortality:
Who, when, where and why?, 2007 The Lancet 368 (9542):1189-1200
www.womendeliver.org/pdf/Maternal_Lancet_series.pdf
49 United Nations, The Millennium Development
Goals Report 2007, UN
http://www.un.org/millenniumgoals/pdf/mdg2007.pdf
50 DFID spent £45m on health research in
2005-06 and is doubling its finance to research by 2010-11 and
revisiting its research strategy.
51 The cost of scaling up essential health services
for childbearing women, as well as the intrinsically linked healthcare
services to save the lives of their newborns has been estimated
at $US1.2 billion in 2007 rising to $US6.1 billion in 2015 for
the 75 developing countries most in need. Estimating the Cost
of Scaling-up Maternal and Newborn Health Interventions to Reach
Universal Coverage: methodology and assumptions Technical Working
Paper Department of Making Pregnancy Safer (FCH/MPS) and Health
Systems Financing (EIP/HSF) for the World Health Report 2005 March
2005 World Health Organization.
52 Cleland, J, Bernstein, S, Ezeh, A, Faundes,
A, Glasier, A. And Innis, J. (2007) Family planning: The unfinished
agenda, The Lancet 368(9549), pp 1810-1827 www.thelancet.com/collections/series/srh
53 Glasier, A, Gulmezoglu, A M, Schmid, G P,
Moreno, CG and van Look, PFA (200 Sexual and reproductive health:
A matter of life and death The Lancet Vol 368, Issue 9547, pp
1595-1607
54 Adding it Up The Benefits of Investing In
Sexual and Reproductive Health Care (2004) UNFPA and the Alan
Guttmacher Institute, http://www.unfpa.org/publications/detail.cfm?ID=162
55 Options (2007) Scaling up action to mitigate
the impact of HIV on maternal and child health: Beyond PMTCT,
London
56 Jeremy Shifmann identifies three groups of
factors which determine the level of political priority for maternal
health: transnational influence (eg efforts by / resources from
international actors; domestic advocacy; and national political
environment). J Shiffman, "Generating political priority
for public health causes in developing countries: Implications
from a study on maternal mortality. CGD brief. www.cgdev.org.
57 World Health Report 2006—working together
for health, Geneva http://www.who.int/whr/2006/en/
58 WHO (2005) World Health Report 2005—Make
every mother and child count, Geneva
http://www.who.int/whr/2005/en/
59 The project was unable to bring about change
due to a complex mixture of factors; the crisis in human resources,
a weak health system with minimal referral capacity, a lack of
focus on family planning and preventing unsafe abortion, all during
a period in which the impact of AIDS on maternal deaths was rising,
but remained hidden (HIV testing was not available at that time).
60 DFID Maternal Health Factsheet 2007
61 Position Paper on Sexual and Reproductive
Health and Rights; Policy Position on Preventing Unsafe Abortion;
Taking Action (and forthcoming AIDS strategy); DFID's White Paper,
"Eliminating World Poverty: making governance work for the
poor" (2006) committed us to making our work on gender equality
and women's rights more of a priority; The Health Strategy (2007),
and Gender Equality Action Plan GEAP (2007) reinforce DFID's commitment
to gender equality and rights as core elements in DFID's approach.
62 Lancet Maternal Survival Series, Sept 2006
63 DFID has had a Policy Position Paper on Preventing
Unsafe Abortion since 2001, which includes further detail of ways
DFID works to reduce unsafe abortion.
64 Cleland, J, Bernstein, S, Ezeh, A, Faundes,
A, Glasier, A and Innis, J. (2007) Family Planning, the unfinished
agenda, Lancet Reproductive Health Series
65 State of World Population 2005. The Promise
of Equality: Gender Equity, Reproductive Health and the Millennium
Development Goals. UNFPA. 2005. 65.
66 A Moore, et al Coercive First Sex among Adolescents
in Sub-Saharan Africa: Prevalence and Context
67 WHO, Multi-country Study on Women's Health
and Domestic Violence against Women, 2005
68 A Moore, et al Coercive First Sex among Adolescents
in Sub-Saharan Africa: Prevalence and Context
69 The 1994 Cairo International Conference on
Population and Development (ICPD) is an international consensus
setting out a framework for action, which the UK supports. It
set out a new approach to population issues, one based on improving
the status of woman and advancing their reproductive health and
rights and it continues to be useful. The UK worked hard to ensure
that the key ICPD goal of universal access to reproductive health
by 2015 was clearly affirmed at the September 2005 World Summit.
70 UNICEF(2005) Female genital mutilation/cutting:
A statistical exploration, New York
71 Government of Burundi Health Management Information
System
72 This table shows a sample of DFID's major
investments through a variety of channels but is not an exhaustive
list.
73 HLSP 2007 report, Aid instruments for AIDS
and SRH
| 
