Academic journal article Bulletin of the World Health Organization

A Financial Road Map to Scaling Up Essential Child Health Interventions in 75 countries/Marche a Suivre Sur le Plan Financier Pour la Mise a L'echelle Nationale Des Interventions Essentielles Pour la Sante Infantile Dans 75 pays/Hoja De Ruta Financiera Para Expandir Las Intervenciones De Salud Infantil Esenciales En 75 Paises

Academic journal article Bulletin of the World Health Organization

A Financial Road Map to Scaling Up Essential Child Health Interventions in 75 countries/Marche a Suivre Sur le Plan Financier Pour la Mise a L'echelle Nationale Des Interventions Essentielles Pour la Sante Infantile Dans 75 pays/Hoja De Ruta Financiera Para Expandir Las Intervenciones De Salud Infantil Esenciales En 75 Paises

Article excerpt

Introduction

Global reductions in child mortality have stagnated, and annually almost 11 million children die before their fifth birthday, mainly from preventable illnesses. (1) In many countries, a reversal in progress highlights the failure to reach children and to provide known and effective interventions.

The fourth Millennium Development Goal--to reduce child mortality by two-thirds by 2015--is ambitious but achievable. (2) The World health report 2005 identifies technical strategies to improve the health of mothers, newborns and children. (3) With only a decade left to reach the Millennium Development Goal targets, policies more firmly related to implementation are needed. Budget assessments are a necessary step in moving from vision to implementation of strategic plans.

Previous attempts have been made to estimate the costs of scaling up delivery of child health interventions including the United Nations Millennium Project's needs assessments. Findings from case studies from five countries estimated the total investments in child health needed per capita in 2015: these ranged from US$ 3.80 in Ghana to US$ 6.80 in Uganda. (4) The Commission on Macroeconomics and Health estimated the economic costs of scaling up health interventions that address childhood-related illnesses in 83 countries, projecting as far as 2015. This commission found that an additional US$ 11.9 billion would be needed per year above current expenditures. (5) Further, members of the Bellagio Study Group on Child Survival assessed the running costs of providing 23 interventions to improve child survival in 42 countries; the cost was estimated to be US$ 5.1 billion in new resources annually. (6)

Our study was conducted because none of the pre-existing cost estimates forecast the additional financial funds required year-by-year for scale-up. Estimates presented by the UN Millennium Project represent total rather than incremental costs. The estimates made by the Commission on Macroeconomics and Health reflect an economic perspective rather than financial expenditures. The price tag presented by members of the Bellagio group estimate the additional running costs once interventions have been successfully scaled up to full coverage rather than the increasing costs of scaling up health service delivery over time. We believe that yearly estimates of financial needs are essential to guide the advocacy for raising funds to reach the fourth Millennium Development Goal. This study provides the first estimate of the incremental financial resources required over 10 years to scale up child health interventions to universal coverage by 2015, and it includes programme investments as well as running costs.

We acknowledge that child survival depends on maternal survival and pregnancy care as well as factors outside the health sector (e.g. women's education, access to dean air and water, and improvements in infrastructure). However, for this study, we limited the list of interventions to those generally failing under the responsibility of what are known as "child health programmes". As such, these estimates are intended to provide a financial road map that is useful for child health practitioners, managers of national and international organizations and programmes providing interventions that are key to children's survival, and donors considering funding interventions to attain this goal.

Methods, assumptions and data sources

This section summarizes the methods used. For greater detail on the key assumptions underlying the models, please see the relevant technical working paper. (7)

The development of a financial road map for scaling up essential child health interventions required us to select countries for the analysis, to identify priority interventions, to estimate the population in need of each service, to define current and target coverage of interventions, and to collect country-specific costs associated with the delivery of interventions. …

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