Countdown to 2015: an analysis of donor funding for prenatal and neonatal health, 2003-2013

Abstract

Background: In 2015, 5.3 million babies died in the third trimester of pregnancy and first month following birth. Progress in reducing neonatal mortality and stillbirth rates has lagged behind the substantial progress in reducing postneonatal and maternal mortality rates. The benefits to prenatal and neonatal health (PNH) from maternal and child health investments cannot be assumed.

Methods: We analysed donor funding for PNH over the period 2003-2013. We used an exhaustive key term search followed by manual review and classification to identify official development assistance and private grant (ODA+) disbursement records in the Countdown to 2015 ODA+ Database.

Results: The value of ODA+ mentioning PNH or an activity that would directly benefit PNH increased from $105 million in 2003 to $1465 million in 2013, but this included a 3% decline between 2012 and 2013. Projects exclusively benefitting PNH reached just $6 million in 2013. Records mentioning PNH accounted for 3% of the $2708 million disbursed in 2003 for maternal, newborn and child health (MNCH) and increased to 13% of the $9287 million disbursed for MNCH in 2013. In 11 years, only nine records ($6 million) mentioned stillbirth, miscarriage, or the fetus, although the two leading infectious causes of stillbirth were mentioned in records worth $832 million. The USA disbursed the most ODA+ mentioning PNH ($2848 million, 40% of the total) and Unicef disbursed the most ODA+ exclusively benefitting PNH ($18 million, 30%). We found evidence that funding mentioning and exclusively benefitting PNH was targeted to countries with greater economic needs, but the evidence of targeting to health needs was weak and inconsistent.

Conclusions: Newborn health rose substantially on the global agenda between 2003 and 2013, but prenatal health received minimal attention in donor funding decisions. Declines in 2013 and persistently low funding exclusively benefitting PNH indicate a need for caution and continued monitoring of donors' support for newborn health.

Figure 1

ODA+ for prenatal and neonatal health, 2003–2013, from 54 donors to 156 recipient countries. (A) Presents the full disbursement value of non-research ODA+ mentioning PNH, broken down by whether the funding exclusively benefitted PNH or also benefitted other population groups. It also illustrates how the funding mentioning PNH was categorised within the Countdown framework for estimating the value of funding for maternal, newborn and child health (MNCH). For each record mentioning PNH, between 0% and 100% of the full value of the disbursement may be counted towards the Countdown's estimates of funding for ‘maternal and newborn health’ (MNH) or ‘child health’. (B) presents ODA+ for MNCH based on estimates produced by the Countdown to 2015; within these estimates are highlighted the value of funding from records which exclusively benefitted PNH and those which mention PNH but also benefit others. ODA+, official development assistance plus private grants; PNH, prenatal and neonatal health.

Figure 2

Maps: Variation by recipient country in ODA+ mentioning PNH in total and per live birth, 2003–2013. (A) Presents variation in total ODA+ mentioning PNH by recipient country. (B) Presents variation in ODA+ mentioning PNH per birth by recipient country. Data are presented in constant 2013 US$ and were prepared in ArcGIS V.10.3. ODA+, official development assistance plus private grants; PNH, prenatal and neonatal health.

Figure 3

Targeting of ODA+ mentioning prenatal and neonatal health (PNH) to countries with the greatest need, 2003–2013. The four scatter plots present the association between the amount of official development assistance and private grants (ODA+) received by each country and the neonatal mortality rate (our metric of health needs) in that country. Data points are colour-coded by country income group to provide an indication of their economic need. The four scatter plots show total funding over the 11-year period (plots A and B) and average ODA+ per birth (plots C and D) that mentions PNH (plots A and C) and that exclusively benefits PNH (plots B and D).