title: Countdown to 2015 country case studies: what can analysis of national health financing contribute to understanding MDG 4 and 5 progress?
abstract: Countdown to 2015 (Countdown) supported countries to produce case studies that examine how and why progress was made toward the Millennium Development Goals (MDGs) 4 and 5. Analysing how health-financing data explains improvements in RMNCH outcomes was one of the components to the case studies.
  
  
  
  This paper presents a descriptive analysis on health financing from six Countdown case studies (Afghanistan, Ethiopia, Malawi, Pakistan, Peru, and Tanzania), supplemented by additional data from global databases and country reports on macroeconomic, health financing, demographic, and RMNCH outcome data as needed. It also examines the effect of other contextual factors presented in the case studies to help interpret health-financing data.
  
  
  
  Dramatic increases in health funding occurred since 2000, where the MDG agenda encouraged countries and donors to invest more resources on health. Most low-income countries relied on external support to increase health spending, with an average 20-64 % of total health spending from 2000 onwards. Middle-income countries relied more on government and household spending. RMNCH funding also increased since 2000, with an average increase of 119 % (2005-2010) for RMNH expenditures (2005-2010) and 165 % for CH expenditures (2005-2011). Progress was made, especially achieving MDG 4, even with low per capita spending; ranging from US$16 to US$44 per child under 5 years among low-income countries. Improvements in distal factors were noted during the time frame of the analysis, including rapid economic growth in Ethiopia, Peru, and Tanzania and improvements in female literacy as documented in Malawi, which are also likely to have contributed to MDG progress and achievements.
  
  
  
  Increases in health and RMNCH funding accompanied improvements in outcomes, though low-income countries are still very reliant on external financing, and out-of-pocket comprising a growing share of funds in middle-income settings. Enhancements in tracking RMNCH expenditures across countries are still needed to better understand whether domestic and global health financing initiatives lead to improved outcomes as RMNCH continues to be a priority under the Sustainable Development Goals.
authors.affiliation: Global Health and Population Department, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA. cmann@hsph.harvard.edu.
authors.forename: Carlyn
authors.initials: C
authors.lastname: Mann
authors.affiliation: Global Health and Population Department, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA.
authors.forename: Courtney
authors.initials: C
authors.lastname: Ng
authors.affiliation: Centre for Global Child Health, The Hospital for Sick Children, Toronto, M5G 1X8, Canada.
authors.forename: Nadia
authors.initials: N
authors.lastname: Akseer
authors.affiliation: Centre of Excellence in Women and Child Health, Aga Khan University, Karachi, 74800, Pakistan.|Centre for Global Child Health, The Hospital for Sick Children, 686 Bay Street, Toronto, Ontario, M5G 0A4, Canada.|Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
authors.forename: Zulfiqar A
authors.initials: ZA
authors.lastname: Bhutta
authors.affiliation: London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK.
authors.forename: Josephine
authors.initials: J
authors.lastname: Borghi
authors.affiliation: Institute for Global Health, University College London, London, WC1N 1EH, UK.
authors.forename: Tim
authors.initials: T
authors.lastname: Colbourn
authors.affiliation: Netherlands Interdisciplinary Demographic Institute (NIDI), The Hague, NL-2511 CV, The Netherlands.
authors.forename: Patricia
authors.initials: P
authors.lastname: Hernández-Peña
authors.affiliation: Centro de Investigación para el Desarrollo Integral y Sostenible and School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru.|School of Medicine, Universidad Nacional Mayor de San Marcos, Lima, Peru.|Instituto Nacional de Salud del Niño, Lima, Peru.
authors.forename: Luis
authors.initials: L
authors.lastname: Huicho
authors.affiliation: Centre of Excellence in Women and Child Health, Aga Khan University, Karachi, 74800, Pakistan.
authors.forename: Muhammad Ashar
authors.initials: MA
authors.lastname: Malik
authors.affiliation: London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK.
authors.forename: Melisa
authors.initials: M
authors.lastname: Martinez-Alvarez
authors.affiliation: Economics Department, University of Malawi, Zomba, Malawi.
authors.forename: Spy
authors.initials: S
authors.lastname: Munthali
authors.affiliation: London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK.
authors.forename: Ahmad Shah
authors.initials: AS
authors.lastname: Salehi
authors.affiliation: Ethiopian Public Health Institute, Health System Research, Addis Ababa, Ethiopia.
authors.forename: Mekonnen
authors.initials: M
authors.lastname: Tadesse
authors.affiliation: Ethiopian Public Health Institute, Health System Research, Addis Ababa, Ethiopia.
authors.forename: Mohammed
authors.initials: M
authors.lastname: Yassin
authors.affiliation: Global Health and Population Department, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA.
authors.forename: Peter
authors.initials: P
authors.lastname: Berman
mesh_terms: D002648:Child; D002675:Child, Preschool; D003695:Delivery of Health Care / Q000191:economics / Q000458:organization & administration*; D003906:Developing Countries; D057217:Economic Development; D005260:Female; D005378:Financial Support; D014943:Global Health; D061889:Healthcare Financing; D006801:Humans; D007182:Income
keywords: Afghanistan; Child health; Ethiopia; Health finance; Malawi; Maternal health; Newborn health; Pakistan; Peru; Reproductive health; Tanzania