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Falling aid for reproductive, maternal, newborn and child health in the lead-up to the COVID-19 pandemic

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Catherine Pitt, David Bath, Peter Binyaruka, Josephine Borghi, Melisa Martinez-Alvarez

Summary box

  • Greater investment in reproductive, maternal, newborn and child health (RMNCH) is needed to mitigate the negative effects of COVID-19 and avoid a reversal of recent gains in RMNCH coverage and outcomes.

  • Aid for RMNCH as a whole fell by 6% between 2017 and 2018 and only increased by 2% in 2019; over the same 2-year period, aid for the reproductive health of non-pregnant women fell by 25%.

  • Volatile and falling aid for RMNCH may have rendered RMNCH systems more fragile in the 2 years preceding the COVID-19 pandemic.

  • We encourage everyone—academics, advocates and policy makers—to explore and exploit the Muskoka2 aid for RMNCH dataset and other aid datasets, as part of efforts to improve RMNCH outcomes.

Introduction

Infectious disease epidemics pose a threat to reproductive, maternal, newborn and child health (RMNCH) both directly—by worsening women’s and children’s health outcomes—and indirectly—by reducing their access to services.1–4 Greater investment is therefore needed to mitigate the negative effects of COVID-19 and avoid a reversal of recent gains in RMNCH coverage and outcomes.1 However, COVID-19 has reduced household and government budgets,5 and there are concerns about the extent to which resources have been diverted away from RMNCH.

Alongside domestic government financing and household out-of-pocket expenditure, aid plays a substantial role in funding RMNCH services in many countries. In 2018, for example, aid accounted for 25% of current health expenditure in the 45 least developed countries.6 Across the 23 countries with RMNCH expenditure estimates for 2018, aid accounted for a median of 22% of RMNCH expenditure, ranging from <1% in Namibia and the Seychelles up to 64% of child health and 84% of reproductive and maternal health expenditure in South Sudan.6 Yet, aid is volatile,7 subject to changing political priorities and not always responsive to needs.6 Global economic crises can lead to reduced aid levels and change the nature and sources of funding.8 Tracking disbursements of aid for RMNCH is therefore important for holding donors accountable for their commitments, including before, during and after crises.