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. 2016 Sep 12;16 Suppl 2(Suppl 2):792.
doi: 10.1186/s12889-016-3403-4.

Countdown to 2015 country case studies: what can analysis of national health financing contribute to understanding MDG 4 and 5 progress?

Carlyn Mann  1 , Courtney Ng  2 , Nadia Akseer  3 , Zulfiqar A Bhutta  4   5   6 , Josephine Borghi  7 , Tim Colbourn  8 , Patricia Hernández-Peña  9 , Luis Huicho  10   11   12 , Muhammad Ashar Malik  4 , Melisa Martinez-Alvarez  7 , Spy Munthali  13 , Ahmad Shah Salehi  7 , Mekonnen Tadesse  14 , Mohammed Yassin  14 , Peter Berman  2 ; Countdown to 2015 Health Finance Working Group
Collaborators, Affiliations

Countdown to 2015 country case studies: what can analysis of national health financing contribute to understanding MDG 4 and 5 progress?

Carlyn Mann et al. BMC Public Health. .

Abstract

Background: Countdown to 2015 (Countdown) supported countries to produce case studies that examine how and why progress was made toward the Millennium Development Goals (MDGs) 4 and 5. Analysing how health-financing data explains improvements in RMNCH outcomes was one of the components to the case studies.

Methods: This paper presents a descriptive analysis on health financing from six Countdown case studies (Afghanistan, Ethiopia, Malawi, Pakistan, Peru, and Tanzania), supplemented by additional data from global databases and country reports on macroeconomic, health financing, demographic, and RMNCH outcome data as needed. It also examines the effect of other contextual factors presented in the case studies to help interpret health-financing data.

Results: Dramatic increases in health funding occurred since 2000, where the MDG agenda encouraged countries and donors to invest more resources on health. Most low-income countries relied on external support to increase health spending, with an average 20-64 % of total health spending from 2000 onwards. Middle-income countries relied more on government and household spending. RMNCH funding also increased since 2000, with an average increase of 119 % (2005-2010) for RMNH expenditures (2005-2010) and 165 % for CH expenditures (2005-2011). Progress was made, especially achieving MDG 4, even with low per capita spending; ranging from US$16 to US$44 per child under 5 years among low-income countries. Improvements in distal factors were noted during the time frame of the analysis, including rapid economic growth in Ethiopia, Peru, and Tanzania and improvements in female literacy as documented in Malawi, which are also likely to have contributed to MDG progress and achievements.

Conclusions: Increases in health and RMNCH funding accompanied improvements in outcomes, though low-income countries are still very reliant on external financing, and out-of-pocket comprising a growing share of funds in middle-income settings. Enhancements in tracking RMNCH expenditures across countries are still needed to better understand whether domestic and global health financing initiatives lead to improved outcomes as RMNCH continues to be a priority under the Sustainable Development Goals.

Keywords: Afghanistan; Child health; Ethiopia; Health finance; Malawi; Maternal health; Newborn health; Pakistan; Peru; Reproductive health; Tanzania.

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Figures

Fig. 1
Fig. 1
Trend and percent change in total health expenditure (THE) by country. a Afghanistan. b Ethiopia. c Malawi. d Pakistan. e Peru. f Tanzania
Fig. 2
Fig. 2
Trend of reproductive, maternal, newborn and child health (RMNCH) expenditures for Ethiopia, Malawi, and Tanzania (constant 2012 US$). a Reproductive, maternal and child health expenditures by country (Ethiopia, Malawi, and Tanzania). b Reproductive and maternal health spending per woman of reproductive age and child health expenditure per child under-5 years for Ethiopia and Malawi. c Reproductive and maternal health spending per woman of reproductive age and child health expenditure per child under-5 years for Peru. Note: Peru’s per capita reproductive, maternal, newborn and child health (RMNCH) expenditures are substantially higher and with all three (Ethiopia, Malawi, and Peru) graphed together, the changes in per capita reproductive, maternal, newborn and child health (RMNCH) expenditure at 2005 and after would not be as visually noticeable
Fig. 3
Fig. 3
Total reproductive, maternal, newborn and child health (RMNCH) expenditure relative to total health expenditure for Ethiopia, Malawi, Tanzania, and Afghanistan (constant 2012 US$). a Ethiopia. b Malawi. c Tanzania. d Afghanistan
Fig. 4
Fig. 4
Total health expenditure by funding sources by country (constant 2012 US$). a Malawi health expenditure. b Tanzania health expenditure. c Afghanistan health expenditure. d Pakistan health expenditure. e Peru health expenditure. f Ethiopia health expenditure
Fig. 5
Fig. 5
reproductive, maternal, newborn and child health (RMNCH) expenditure trend by funding sources for Ethiopia, Malawi, and Tanzania (constant 2012 US$). a Ethiopia reproductive and maternal health expenditure. b Malawi reproductive and maternal health expenditure. c Tanzania reproductive and maternal health expenditure. d Ethiopia child health expenditure. e Malawi child health expenditure. f Tanzania child health expenditure
Fig. 6
Fig. 6
Maternal mortality rates and percent decline from 1990–2013 with most recent maternal health per capita spending by country. * No per capita reproductive health expenditure data is available. Note: Parentheses under countries is the most recent year with maternal health expenditure data
Fig. 7
Fig. 7
Percent decline for U5MR and health spending per under-5 child by country. *Per capita child health expenditure data is not available. Note: Parentheses under countries is the most recent year with child health expenditure data. Countries within the blue area achieved MDG 4.
Fig. 8
Fig. 8
Per capita health spending by country for most recent year (constant 2012 US$)
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References

    1. Moucheraud C, Owen H, Singh N, Ng C, Requejo J, Lawn J, Berman P: Countdown to 2015 country case studies: what have we learned about processes and progress towards MDGs 4 and 5? BMC Public Health 2016. doi:10.1186/s12889-016-3401-6 - PMC - PubMed
    1. The World Bank: World DataBank. World Development Indicators, Macroeconomic data on Afghanistan, Ethiopia, Malawi, Peru, Pakistan, and Tanzania. In. http://databank.worldbank.org/data/reports.aspx?source=world-development.... (Accessed April 2015).
    1. United Nations: The Millennium Development Goals Report 2005. In. http://unstats.un.org/unsd/mi/pdf/mdg%20book.pdf (Accessed Apr 2015).
    1. International Institute for Sustainable Development (IISD): MDG Summit Bulletin, A report of the High-level Plenary Meeting of the 65th Session of the UN General Assembly on the Millennium Development Goals (MDGs). Final Issue 2010, 153(9). In. http://www.iisd.ca/download/pdf/sd/ymbvol153num9e.pdf. (Accessed Dec 2015).
    1. Rajkumar AS, Swaroop V. Public spending and outcomes: Does governance matter? J Dev Econ. 2008;86(1):96–111. doi: 10.1016/j.jdeveco.2007.08.003. - DOI