Donor Commitments and Disbursements for Sexual and Reproductive Health Aid in Kenya, Tanzania, Uganda and Zambia

Abstract

Background: Sexual and Reproductive Health and Rights (SRHR) investments are critical to people's well-being. However, despite the demonstrated returns on investments, underfunding of SRHR still persists. The objective of this study was to characterize donor commitments and disbursements to SRH aid in four sub-Saharan countries of Kenya, Tanzania, Uganda and Zambia and to compare trends in donor aids with SRH outcome and impact indicators for each of these countries.Methods: The study is a secondary analysis of data from the Organization for Economic Co-operation and Development's Assistance creditor reporting system and SRH indicator data from the Global Health Observatory and country demographic health surveys for a 16-year period (2002–2017). We downloaded and compared commitments to disbursements of all donors for population policies, programs and reproductive health for the four African countries. SRH indicators were stratified into health facility level process/outcome indicators (modern contraceptive prevalence rate, unmet need for family planning, antenatal care coverage and skilled birth attendance) and health impact level indicators (maternal mortality ratio, newborn mortality rate, infant mortality rate and under five mortality rate).Results: Donor commitments for SRH aid grew on average by 20% while disbursements grew by 21% annually between 2002 and 2017. The overall disbursement rate was 93%. Development Assistance Cooperation (DAC) countries donated the largest proportion (79%) of aid. Kenya took 33% of total aid, followed by Tanzania 26%, Uganda 23% and then Zambia (18%). There was improvement in all SRH outcome and impact indicators, but not enough to meet targets.Conclusion: Donor aid to SRH grew over time and in the same period indicators improved, but improvement remained slow. Unpredictability and insufficiency of aid may be disruptive to recipient country planning. Donors and low- and middle-income countries should increase funding in order to meet global SRHR targets.

Sexual and reproductive health and rights in humanitarian settings: a matter of life and death

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Rethinking the donor's role in strengthening health systems through sexual and reproductive health and rights partnerships: A qualitative analysis of Ugandan case studies

“…Still, evidence on the effectiveness of foreign aid support in the health sector remains mixed (Odokonyero et al, 2018). Financial donor support for SRHR in Uganda has increased over the past two decades, and sexual and reproductive health indicators have improved but not fast enough to achieve SDG targets (Kibira et al, 2021). Uganda's health sector receives 5.1% of the total government budget, a third of the Abuja target set over 20 years ago (Abuja Declaration on HIV/AIDS, Tuberculosis and Other Related Infectious Diseases, 2001; UNICEF, 2020).…”

Policy analysis of the Global Financing Facility in Uganda

“…Uganda has made significant progress in Reproductive, Maternal, Newborn, Child and Adolescent Health (RMNCAH)). Nonetheless, it remains with high burdens of maternal and child mortality, requiring additional global resources to support the relevant programmes [ 3–5 ].…”