Knowledge Summary 3: Cost and fund RMNCH programmes
Spending on women's and children's health is an investment, not just a cost, contributing to the well-being of families and communities, and to a nation's socio-economic development. Estimating costs and raising the required funds, and ensuring efficient and effective use of these resources, are key responsibilities - enabling "more money for health" and "more health for the money".
Accurate and up-to-date information on the costs of reproductive, maternal, newborn and child health (RMNCH) programs and interventions is needed.This can inform the formulation of national health policies, strengthen arguments for the required investments to achieve national health targets, and help countries and their partners to plan, budget and monitor the delivery of essential services to ensure the health of women, adolescent girls, newborns and children.
Many methods are used to estimate the resources required. Financial estimates may vary depending on the costing tools and approaches used, the interventions included, and the projected timescales (see Table 1).The first step in securing and using funding effectively is thus to prioritize and estimate the costs of high-impact RMNCH interventions (see Knowledge Summary 4). Countries and their partners can use the Lives Saved Tool (LiST) both to estimate the impact of scaling-up interventions and to inform planning for RMNCH.
The Global Strategy for Women’s and Children’s Health employed a combination of two approaches to determine the global funding gap1 The WHO approach estimated the resources required to scale-up country health systems to a level that is considered “best practice” by experts and practitioners. The Marginal Budgeting for Bottlenecks approach focused on budgeting based on removing critical constraints in existing health systems in order to scale-up a set of proven interventions. Using these two costing strategies, the Global Strategy estimates that the funding gap for women’s and children’s health in the 49 poorest countries ranges from US$14 billion (US$10 per capita) in 2011 to US$22 billion (US$14 per capita) in 2015.
At the national level, policymakers and program managers can use a range of costing tools to make funding decisions. A technical review of 13 such costing tools linked to the health Millennium Development Goals (MDGs) identified the questions they answer, whether they do so in a technically correct manner, and assessed their user friendliness. The review emphasized that national cost estimates are strongly dependent on data availability and quality. Each tool was found to be helpful for different costing purposes, and, with adequate user training, could inform country strategies and plans.Raising funds
While health spending by governments, donor agencies and the private sector has increased, current funds remain insufficient to achieve MDGs 4 and 5. Governments, donor agencies, non-governmental organizations and the private sector have together pledged an estimated US$40 billion for women’s and children’s health over the next five years.3 Whilst this headline figure is still being refined, it is already clear that more is needed.Channeling funds well
Efficient and targeted use of funds is key to helping to improve the health of the poorest and most vulnerable women and children.To ensure sustainability of investment and promote universal access, funding must help to strengthen health systems by improving service delivery, the health workforce, information, medical products, vaccines and technologies, leadership and accountability (see Knowledge Summaries 5, 6,8 and 12).
Efficiency in funding is often impeded by poor donor coordination and alignment with national priorities.This can pose serious challenges in relation to national budgets and planning is weak. For example, in 2008, about 0% of donor support for MNCH was for specific projects rather than sector-wide funding or general budget support.
A range of innovative funding mechanisms are being developed and deployed to improve the efficiency and effectiveness of RMNCH funding. Results-based financing, for instance, could increase the impact of investments by providing incentives for better performance and results (see Box 2 and Figure 2).
For the funds for RMNCH to be used more efficiently and effectively, interventions have to be prioritized, taking into account the local epidemiological and health systems context.The costs of implementation can be estimated with the help of tools developed for this purpose. Funds can be raised from governments and donors, and from non-traditional sources such as the business community and global philanthropic institutions. Innovative mechanisms for channeling funds can increase the efficiency and impact of investments by rewarding performance. Finally, the use of funds needs to be tracked and monitored to ensure accountability (see Knowledge Summary 12).