UK invests in large-scale programmes, but neglects health systems components
Our portfolio review found a number of active UK ODA projects which are focused on improving maternal, newborn and child health. Many DFID bilateral aid programmes prioritise interventions to tackle newborn, child and maternal mortality such as immunisation, skilled birth attendance and antenatal care. Flagship initiatives like the Maternal and Newborn Child Health Programme (£133.2 million) in Nigeria and Reducing Maternal and Newborn Deaths in Kenya (£64.7 million) target both goals. DFID’s large programmes which focus on humanitarian needs include similar maternal and child health interventions, as do the majority of broader health system support grants. Prevention and treatment of malaria and other major diseases affecting children like pneumonia also feature strongly within DFID’s health system support programmes, including the Malawi Health Sector Support Programme (£109.8 million). Additionally, the Somali Health and Nutrition Programme (£89.6 million) is an example of effective integration of nutrition services into other health service provision, although this does not extend to most DFID health programmes.
However, a 2018 ICAI review into DFID’s maternal health programmes between 2010-15 found that DFID has expanded access to some health services, but ‘in the face of severe shortages of skilled personnel, equipment and supplies, [DFID] has struggled to raise service quality to the extent needed to improve maternal health outcomes.' An unbalanced portfolio across family planning, health services and other interventions has failed to maximise impact and seen insufficient focus on strengthening national health infrastructure to deliver sustainable improvements. DFID’s preference to work with non-state providers has, in many cases, been found to risk displacing public sector provision. While ICAI found DFID was working to extend services into poor and remote areas, efforts to reach poor, young and marginalised women were insufficient.
Beyond bilateral programmes, many UK Government investments in multilaterals support reproductive, maternal, newborn child and adolescent health – including the backing of the Global Financing Facility and Health Results Innovation Trust Fund. UK backing of the Global Fund to Fight AIDS, TB and Malaria, UNITAID and other multilaterals have also contributed to child health, through supporting paediatric antiretrovirals to treat HIV for example. The UK’s £400 million backing of the Global Polio Eradication Initiative for the period 2013- 19 has similarly made a significant contribution to child health, with polio confined to just two countries as of 2017.
Maternal and child health feature within the UK Government’s strong health research portfolio too. Large-scale UK ODA investments across family planning, health systems – and outside of the scope of this analysis nutrition, and water and sanitation – also contribute to SDG targets 3.1 and 3.2.
© 2020 ACTION FOR GLOBAL HEALTH Action for Global Health (AfGH) is a membership network of more than 50 UK-based organisations. AfGH is currently hosted by STOPAIDS
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