Tracking Official Development Assistance for Reproductive Health in Conflict-Affected Countries: 2002 to 2011 Preeti Patel 1, Maysoon Dahab 2, Mihoko Tanabe 3, Lydia Ettema 4, Samantha Guy 5 and Bayard Roberts 6 1 Lecturer, Global Health and Security, Department of War Studies, King’s College London 2 Head 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 Funded by: by the Bureau for Population, Refugee and Migration and the MacArthur Foundation, through the Women’s Refugee Commission

Research Purpose and Objectives 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 Purpose: To provide longer-term trends in patterns of ODA disbursement for RH activities in 18 conflict-affected countries from 2002 to 2011

Methodology Data Source Creditor Reporting System (CRS) maintained by Development Assistance Committee (DAC) of the Organisation of Economic Cooperation and Development (OECD) – – 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 (Uppsala definition) so includes post-conflict

Data Analysis CRS data for 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-conflict- affected ‘least developed countries’

[ Direct activities % allocatedIndirect activities % allocated Population policy & admin. Management100 Primary education 10 Reproductive health care100Basic skills for youth and education10 Family planning100Early childhood education10 Personnel d ’ ment for population & RH 100Secondary education10 Social mitigation of HIV/AIDS100Health policy & admin. Management10 HIV/AIDS and STD control100Basic health care25 Basic health infrastructure25 Basic nutrition75 Health education25 Health personnel development25 General budget support2 Material relief assistance and services2 Reconstruction relief and rehabilitation2 CRS activities included

Results: Objective One Absolute ODA for reproductive health to conflict-affected countries 298% increase $1.93 per capita per year

Results: Objective Two Compare RH ODA between conflict-affected countries and non-conflict-affected countries

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)

Results: Objective Three

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 conflict- affected countries : $2.88 million - average annual RH ODA per capita = $

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 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-conflict- affected 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, (6): p. e Patel, P. and B. Roberts, Aid for reproductive health: progress and challenges. Lancet, (9879): p Patel, P., et al., A review of global mechanisms for tracking official development assistance for health in countries affected by armed conflict. Health Policy, (2-3): p 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, (6): p. e Hsu, J., P. Berman, and A. Mills, Reproductive health priorities: evidence from a resource tracking analysis of official development assistance in 2009 and Lancet, (9879): p Warsame, A., P. Patel, and F. Checchi, Patterns of funding allocation for tuberculosis control in fragile states. Int J Tuberc Lung Dis, (1): p