Tracking Expenditure: Where is the RMNCH Money Going?
Tracking spending on health is a vital part of health financing. It can facilitate getting more money for health by collecting and presenting data for holding donors, and national governments, to account for the commitments they make. It is also essential for getting more health for the money. Detailed expenditure information can help governments determine if scarce resources are being used in an efficient manner. It's likely that most countries can make efficiency gains - the World Health Report 2010 estimates that 20-40% of resources for health are wasted.
There are different processes that track health expenditure. National Health Accounts (NHA) track spending at the country-level to monitor trends in health spending for all sectors- public and private, different health care activities, providers, diseases, population groups, and regions in a country. Data collected by NHA are available in WHO's Global Health Observatory. International development assistance for health (DAH) is tracked by the Organisation for Economic Cooperation and Development, and the Institute for Health Metrics and Evaluation (IHME) recently released Financing Global Health 2010 demonstrates that DAH keeps increasing, although at a slower pace, probably as a result of the fiscal crisis and global economic slowdown. It projects total DAH to be US$ 26.9 billion by the end of 2010.
There are also initiatives that focus specifically on spending on RMNCH by donors and domestic sources. While it will not do any actual tracking, the Working Group on Accountability for Resources of the recently established Commission on Information and Accountability for Women's and Children's Health will propose a medium to long-term framework, including indicators and institutional arrangements, for tracking resources for women's and children's health. The Commission's report is expected to be presented in conjunction with the World Health Assembly in May 2011.
The Countdown to 2015 has tracked DAH to MNCH from 2003 through the London School of Hygiene and Tropical Medicine. The most recent study covered DAH to MNCH in 2003-2008. It found that DAH for MNCH amounted to US$ 5.4 billion, equal to a 105% increase since 2003. However, DAH for MNCH as a proportion of total DAH remained constant during the time period. About 70% was allocated to child health, the remaining to maternal and newborn health. IHME also studied DAH for MNCH and came up with a lower estimate than the Countdown to 2015: US$ 3.2 billion.
Child health subaccounts and reproductive health subaccounts within the NHA framework have recently been developed to identify expenditure on RMNCH at the national and sub-national level, information that can be used by governments to determine if that spending corresponds to need. Findings from the countries where the subaccounts have been applied so far suggest that child health accounts for 13%, and reproductive health for 12%, of total health expenditure. Data on health expenditure at the national level is also a critical input into national accountability processes. One initiative to strengthen accountability, the International Budget Partnership works with civil society to strengthen to analyze and influence public budgets in order to hold governments to account.