Tracking Official Development Assistance for Reproductive Health in Conflict-Affected Countries: 2002 to 2011

Preeti Patel1, Maysoon Dahab2, Mihoko Tanabe3, Lydia Ettema4, Samantha Guy5 and Bayard Roberts6

1 Lecturer, Global Health and Security, Department of War Studies, King’s College London2 Head of Global Health, Royal Society of Medicine3 Senior Program Officer, Reproductive Health Program, Women's Refugee Commission4 Policy Advisor, Marie Stopes International5 Associate Director, Marie Stopes International6 Senior Lecturer in Health Systems & Policy, London School of Hygiene & Tropical Medicine

Funded by: by the Bureau for Population, Refugee and Migration and the MacArthur Foundation, through the Women’s Refugee Commission

Research Purpose and Objectives

Objectives1. To measure absolute & per capita amount of RH ODA to 18

conflict-affected countries2. To compare RH ODA disbursed to conflict-affected countries

and non-conflict affected countries 3. To analyse disbursement patterns of RH ODA across

different RH-related activities4. To analyse disbursement patterns of RH ODA across donors

Purpose:To provide longer-term trends in patterns of ODA disbursement for RH activities in 18 conflict-affected countries from 2002 to 2011

Methodology

Data Source• Creditor Reporting System (CRS) maintained by

Development Assistance Committee (DAC) of the Organisation of Economic Cooperation and Development (OECD)– http://stats.oecd.org/Index.aspx?datasetcode=CRS1– Covers 100% of all ODA to developing countries including

conflict-affected countries– Used in other tracking studies (see refs)– Reporting is mandatory for donors (using standard criteria)– 26 bilateral donors and 18 multilateral donors

Sampled Countries: Afghanistan, Angola, Burundi, Central African Republic, Chad, Colombia, Democratic Republic of Congo, Eritrea, Iraq, Liberia, Myanmar, Nepal, Sierra Leone, Somalia, Sri Lanka, Sudan, East Timor, Uganda

Inclusion Criteria: In war at a point between 2000-2009 (Uppsala definition) so includes post-conflict

Data Analysis• CRS data for 2002-2011 for aid disbursements

for 18 conflict-affected countries• All ODA data for each recipient country

downloaded from the CRS database and analysed in Stata and Excel

• CRS purpose codes• Comparative analysis with non-conflict-

affected ‘least developed countries’

Direct activities%

allocated Indirect activities%

allocated

Population policy & admin. Management 100 Primary education 10

Reproductive health care 100 Basic skills for youth and education 10

Family planning 100 Early childhood education 10

Personnel d’ment for population & RH 100 Secondary education 10

Social mitigation of HIV/AIDS 100 Health policy & admin. Management 10

HIV/AIDS and STD control 100 Basic health care 25

Basic health infrastructure 25

Basic nutrition 75

Health education 25

Health personnel development 25

General budget support 2

Material relief assistance and services 2

Reconstruction relief and rehabilitation 2

CRS activities included

Results: Objective OneAbsolute ODA for reproductive health to conflict-affected countries

2002 2003 2004 2005 2006 2007 2008 2009 2010 20110

200

400

600

800

1000

1200

1400

Chart Title

US

$ O

DA

(mill

ions

)

298% increase

$1.93 per capita per year

Results: Objective TwoCompare RH ODA between conflict-affected countries

and non-conflict-affected countries

conflict-affected LDCs non conflict-affected LDCs$0.00

$0.50

$1.00

$1.50

$2.00

$2.50

$3.00

$3.50

$4.00

$2.30

$3.60

Average annual per capita RH ODA

US

$

Results: Objective Two – cont.

Disbursement of RH between 18 sampled conflict-affected countries

• Uganda ($8.1), Timor-Leste ($6.7) and Liberia ($5.4) receive highest RH ODA per capita

• Colombia ($0.2), Myanmar ($0.4) and Sri Lanka ($0.7) receive the least RH ODA per capita

• Despite worse health indicators, Chad ($1.9 per capita) and Somalia ($1.5 per capita) get less RH ODA per capita than East Timor ($6.7 per capita)

Afghanistan

Angola

Burundi

CAR Chad

Colombia

DRC

Eritrea

Iraq

Liberia

Myanmar

Nepal

Sierra Leone

SomaliaSri Lanka

Sudan

Timor-Leste0

.51

1.5

Per

cap

ita r

epro

duct

ive h

ealth

ca

re O

DA

*

0 500 1000 1500 2000Maternal mortality (per 100,000 live births)

*consists of just the CRS purpose code of reproductive health care

Maternal mortality and reproductive health care ODA

2002 2003 2004 2005 2006 2007 2008 2009 2010 20110

200

400

600

800

1000

1200

1400

Indirect activities STD control, including HIV/AIDSSocial mitigation of HIV/AIDS Reproductive health careFamily Planning Population policy and administrative managementPersonnel development for population and RH

OD

A (U

SD$

mill

ions

)

Distribution of reproductive health ODA to conflict-affected countries 2002-2011, by activity (US$ million)

Results: Objective Three

Results: Objective Four

RH ODA disbursement by donors• Main bilateral donors (absolute amounts) – USA, Japan,

Germany and UK• Main bilateral donors (proportional) – Ireland, Denmark

and Iceland• New donors – Czech Republic, Korea and UAE• Main multilateral donors (absolute amounts) – World Bank

and EU• Gates Foundation - Total Gates RH ODA to conflict-affected

countries 2009-2011: $2.88 million- average annual RH ODA per capita = $0.000002

LimitationsGeneral• ODA to countries rather than specific conflict-affected regions

within country• national expenditure data not included• donor disbursement data rather than actual expenditure

CRS • No purpose code for GBV• Can’t determine beneficiaries of ODA• Not all donors report to CRS• Data completeness and accuracy • Descriptive project information sometimes missing• Time lag

Key messages1. Substantial increase (298%) in ODA funding for reproductive health activities to

the 18 conflict-affected countries between 2002 and 2011.

2. Majority of the increase in overall reproductive health funding is explained by increased ODA for HIV/AIDS activities

3. Inequity in funding between conflict-affected countries – winners and losers

4. Inequity in funding between conflict-affected countries and non-conflict-affected least developed countries – conflict-affected countries losing out

5. Gates funding for reproductive health for conflict-affected countries is negligible

6. $1.93 per person per year seems very low but we don’t know what the funding gap is?

7. Need for detailed analysis of in-country RH ODA expenditure – who is benefitting?

8. Need to better understand the relationship between ODA investment and changes in RH outcomes

ReferencesPatel, P., et al., Tracking official development assistance for reproductive health in

conflict-affected countries. PLoS Med, 2009. 6(6): p. e1000090.Patel, P. and B. Roberts, Aid for reproductive health: progress and challenges.

Lancet, 2013. 381(9879): p. 1701-2.Patel, P., et al., A review of global mechanisms for tracking official development

assistance for health in countries affected by armed conflict. Health Policy, 2011. 100(2-3): p. 116-24.

Spiegel, P.B., N. Cornier, and M. Schilperoord, Funding for reproductive health in conflict and post-conflict countries: a familiar story of inequity and insufficient data. PLoS Med, 2009. 6(6): p. e1000093.

Hsu, J., P. Berman, and A. Mills, Reproductive health priorities: evidence from a resource tracking analysis of official development assistance in 2009 and 2010. Lancet, 2013. 381(9879): p. 1772-82.

Warsame, A., P. Patel, and F. Checchi, Patterns of funding allocation for tuberculosis control in fragile states. Int J Tuberc Lung Dis, 2014. 18(1): p. 61-6.