Addressing Critical Knowledge Gaps in Newborn Health

Donor funding for newborns: Translating words into action

By Catherine Pitt on October 31, 2012

Today the open-access journal PLoS Medicine published our analysis providing concrete evidence that from 2002 to 2010, donor agencies dramatically increased their mentions of newborns and of activities benefitting newborns in the descriptions of their projects and programs. That’s the good news. The study also finds that while it’s not possible to provide an exact estimate how much aid really benefits newborns in practice, it seems very unlikely that the funding for newborn interventions is up to the challenge of addressing the 3 million newborn deaths that occur each year.

The value of donor-funded projects and programs mentioning newborns increased tremendously in absolute terms, from $38.4 million in 2002 to $777.3 in 2010 (constant 2010 U.S. dollars). This change also represented a substantial increase relative to total funding for maternal, newborn, and child health (MNCH) activities as a whole. Yet, even in 2010, the $777.3 million in funding mentioning newborns only constituted 12% of the $6.5 billion* in funding for MNCH.

A key problem is that it’s so hard to tell how much of this money is really reaching newborns in practice. The majority of funding mentioning newborns also targeted mothers and older children. Donor funding for non-research projects that exclusively targeted newborns was just $5.7 million in 2010 for all developing countries combined. This figure amounts to 0.01% of donor funding for MNCH. When compared against the 3 million newborn deaths each year, which account for 43% of mortality in children under 5, it seems difficult to justify such limited investment in the cost-effective interventions known to save newborn lives. Importantly, too, there are no signs that this donor funding for projects exclusively benefitting newborns is increasing. 

Stillbirths have remained even less visible. Despite the 2.6 million babies who are stillborn each year, only two projects even mentioned stillbirths in the entire 9-year period studied.

Ensuring that good quality care is provided at all the steps along the continuum from conception, pregnancy and birth, to the neonatal period and beyond is incredibly important and likely to be practical and efficient.  The integration of newborn care activities within broader activities for mothers and older children therefore makes sense, but only if the activities that would help newborns – like antenatal corticosteroids, initiating exclusive breastfeeding within the first 30 minutes of life, and kangaroo mother care – are actually implemented.

Much therefore depends on the policy makers, managers, and front line health workers actually implementing these donor-funded projects and programs. In our paper, we explain:

“At the negative extreme, they may focus all MNCH resources on activities of benefit only to mothers and older children, even where newborns are mentioned in the funding description. At the positive extreme, they may use funding whose description does not explicitly mention newborns to achieve positive synergies by ensuring that, for example, skilled birth attendants not only look after the mother but also prevent stillbirths by monitoring the fetal heart rate and reduce neonatal deaths by performing neonatal resuscitation when necessary. The actual amount of aid benefitting newborns in any given country could therefore conceivably be as low as the value of projects exclusively benefitting newborns, or potentially as high as a major proportion of the total value of the Countdown’s estimates of [aid] to MNCH, if the potential for synergies and double-impact on both the mother and fetus or newborn are taken advantage of and taken into account.”

What can be done?

Donor attention for newborn health has clearly increased and this fact presents a tremendous window of opportunity for everyone concerned about the survival of newborns and the reduction of stillbirths and miscarriages.

Governments, civil society and non-governmental organizations, researchers, donors, and health workers must therefore seize the opportunity by vigilantly monitoring, lobbying, and working with donors and project implementers to ensure the value of funding mentioning newborns continues to increase and that the increasing mention of newborns in funding descriptions translates into substantive actions that improve the survival of the newest and most vulnerable humans – newborns.

* The $6.5 billion for MNCH is from Hsu J, Pitt C, Greco G, Berman P, Mills A, Countdown to 2015: changes in official development assistance to maternal, newborn, and child health in 2009–10, and assessment of progress since 2003. Lancet, 21 September 2012. DOI: 10.1016/S0140-6736(12)61415-9)

 

Additional resources related to  newborn data: