The Global Strategy for Women's and Children's Health has received about $20 billion in new money, according to a new report from The Partnership for Maternal, Newborn & Child Health (PMNCH).
The report, "The PMNCH 2012 Report: Analyzing Progress on Commitments to The Global Strategy for Women's and Children's Health," shows that of this $20 billion, about $10 billion has already been spent.
Commitments to the Global Strategy come from 220 partners; 98 of these are expressed in financial terms, including 27 from low- and middle-income countries.
The Global Strategy, launched by UN Secretary-General Ban Ki-moon two years ago, aims to save the lives of 16 million women and young children in the world's 49 poorest countries by 2015.
Progress is urgently needed. Although the numbers of deaths of women and children are falling steadily at the global level, progress is lacking in many individual countries and regions. Recent reports indicate:
- There are now an estimated 287,000 maternal deaths per year, according to UN partners - a decline of nearly one-half since 1990. However, 1 in 8 births in low-income settings occurs among adolescent girls, and sub-Saharan Africa continues to lag in progress overall;
- On a global level, the UN and partners estimate that child mortality has declined by 41 percent since 1990, from 12 million deaths per year to 6.9 million in 2011. However, many countries, especially in sub-Saharan Africa, are still far off-target in reducing child deaths.
"Most of the gains have come in low-income countries where more than 95 percent of maternal and child deaths occur," says Carole Presern, PhD, Director of PMNCH and a midwife. "Country leadership and evidence-led policy has been key to these gains. However, there is still much to do, and we can't shy away from the remaining challenges. Everyone has a part to play, and everyone needs to think creatively about how we can really demonstrate results."
At this writing, financial commitments of nearly $58 billion in pledges to The Global Strategy for Women's and Children's Health does not include the value of related policy and service delivery commitments, many of which are difficult to monetize.
Progress is occurring, but it remains fragile and uneven, concurs Mickey Chopra, M.D., Chief of Health for UNICEF and co-chair of the Countdown to 2015 movement, which tracks progress towards achieving the Millennium Development health goals for women and children. "National governments and donors must maintain their efforts and investments in maternal and child health. We are excited that even the poorest countries are making big steps forward in terms of money, services and care for reproductive, maternal, newborn and child health," Dr. Chopra says.
The UN attributes the recent gains in mortality reduction to such factors as greater access to skilled delivery care, use of contraception, and increases in female literacy, as well as the spread of new and more effective vaccines, treatment to prevent mother-to-child HIV transmission, increases in use of insecticide-treated bed nets to prevent malaria in children, and improved nutrition, including vitamin A supplementation.
Efforts to meet Millennium Development Goals
The current emphasis on women and children's health dates to the Millennium Development Goals (MDGs) adopted by the UN General Assembly in 2000. MDG 4 calls for a two-thirds reduction in the deaths of children under five by 2015 compared to 1990. MDG 5 calls for three-quarters reduction in maternal deaths and universal access to family planning by 2015, compared to 1990.
In its recent report, Countdown to 2015, which focuses on progress in the 75 highest-burden countries where 95 percent of maternal and young child deaths occur, found that:
- On reducing maternal deaths: Annual maternal deaths are down by 47 percent over the past two decades. Nine Countdown countries are on track to meet their 2015 MDG 5 goal by reducing the maternal mortality rate by 75 percent. But more than a third of the 75 Countdown countries have made little, if any, progress.
- On reducing deaths of children under age 5: Twenty-three Countdown countries are expected to achieve MDG 4. But 13 countries have made no progress in reducing child deaths.
The Global Strategy for Women's and Children's Health was created in 2010, along with the Every Woman Every Child movement, to accelerate action where progress is lagging.
The Global Strategy identified a funding gap of $88 billion between 2011-2015 to save the lives of 16 million women and children by 2015. The new and additional funding of $20 billion would go some way towards narrowing this gap. In total, PMNCH estimates that approximately $10 billion of the initial $58 billion has been spent.
Additionally, recent commitments to preterm birth, child survival, commodities, and family planning, such as the $2.6 billion pledged in July at the London Family Planning Summit, have not yet been tallied as part of the overall pledge total.
The Global Strategy push comes at a critical moment. An assessment of development aid targeted to women's and children's health from 2003-2010 published in a special issue of the Lancet medical journal (forthcoming Sept 28) shows that aid from donor governments and multilateral agencies more than doubled in this period, but that the rate of increase has been slowing since 2008, and declined slightly for the first time between 2009-2010, by $32 million, to $6.48 billion.
"The recent leveling off in aid to maternal, newborn and child health is likely due to the economic crisis," says Justin Hsu, a health economist at the London School of Tropical Medicine and lead author of the Lancet paper and a member of the finance working group of Countdown to 2015. "What is worrisome is that if the leveling off continues, it will have an impact on the provision of child and maternal health services."
A need for better targeting
Authors of all the reports call for better and more precise targeting of funds to areas of greatest need.
The PMNCH analysis showed that donors tend to focus on countries with the largest numbers of maternal and child deaths, like India and Ethiopia, which also receive the most development aid. Other countries are largely ignored. For example, five countries -- Azerbaijan, Congo, Gabon, Sao Tome and Principe, and Turkmenistan -- that are not expected to meet either of the MDG maternal and child goals, received fewer than three commitments each.