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 London
of Global Health, Royal Society of Medicine
3 Senior Program Officer, Reproductive Health Program, Women's Refugee Commission
4 Policy Advisor, Marie Stopes International
5 Associate Director, Marie Stopes International
6 Senior Lecturer in Health Systems & Policy, London School of Hygiene & Tropical Medicine
2 Head
Funded by: by the Bureau for Population, Refugee and Migration and the
MacArthur Foundation, through the Women’s Refugee Commission
Research Purpose and Objectives
Purpose:
To provide longer-term trends in patterns of ODA disbursement
for RH activities in 18 conflict-affected countries from 2002 to
2011
Objectives
1. To measure absolute & per capita amount of RH ODA to 18
conflict-affected countries
2. 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 activities
4. To analyse disbursement patterns of RH ODA across donors
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-conflictaffected ‘least developed countries’
CRS activities included
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
Results: Objective One
Absolute ODA for reproductive health to conflict-affected countries
1400
1200
US $ ODA (millions)
1000
800
600
298% increase
400
$1.93 per capita per year
200
0
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
Results: Objective Two
Compare RH ODA between conflict-affected countries
and non-conflict-affected countries
Average annual per capita RH ODA
$4.00
$3.60
$3.50
$3.00
US $
$2.50
$2.30
$2.00
$1.50
$1.00
$0.50
$0.00
conflict-affected LDCs
non conflict-affected LDCs
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 ($6.7 per capita)
1.5
Maternal mortality and reproductive health care ODA
Timor-Leste
Sierra Leone
Liberia
1
Afghanistan
.5
Eritrea
Nepal
Burundi
0
Sudan
Sri Lanka
Colombia Myanmar
Iraq
0
Chad
CAR
DRC
Somalia
Angola
500
1000
1500
Maternal mortality (per 100,000 live births)
*consists of just the CRS purpose code of reproductive health care
2000
Results: Objective Three
1400
1200
Distribution of reproductive health ODA to conflict-affected
countries 2002-2011, by activity (US$ million)
ODA (USD$ millions)
1000
800
600
400
200
0
2002
2003
2004
2005
2006
2007
2008
2009
2010
Indirect activities
STD control, including HIV/AIDS
Social mitigation of HIV/AIDS
Reproductive health care
Family Planning
Population policy and administrative management
Personnel development for population and RH
2011
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 conflictaffected countries 2009-2011: $2.88 million
- average annual RH ODA per capita = $0.000002
Limitations
General
• 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 messages
1.
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-conflictaffected 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
References
Patel, 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.