Just Beginning: Methodology

The OECD Development Assistance Committee (DAC) Creditor Reporting System (CRS), through which global trends on aid disbursements are measured, does not currently monitor aid disbursements intended for a  particular population. While “rio-markers” have been put in place to advance this objective donor reporting to these are voluntary and many projects remain uncoded according to these rio-markers.

For the purposes of this report, the authors have tried to devise a methodology to track donor support for children aged 0-5 years of age across the health, nutrition, sanitation and education sector. It is important to note that the OECD DAC-CRS database currently does not track aid for “play” and “protection” which are likely to be very relevant for the 0-5 years age-group.

For the analysis in the report, the report built on selecting from a number of current methods that have been in existence to track donor support to Maternal, Newborn and Child Health (MNCH) since the 2010 Muskoka Commitment which was intended to increase donor support to MNCH (G8, 2010).

This report builds upon the Muskoka Methodology – devised by the G8 Health Working Group – which is used to capture donor aid disbursements to MNCH related activities. This Muskoka Methodology is used to capture aid to two groups: (a) women of reproductive age (including those who are pregnant and (b) children under the age of five. For the purposes of this report, we are interested in capturing the aid that goes to (b). This paper has utilised these assumptions and built upon them to try and arrive at a global estimate as to what donors are disbursing to children under the age of five years old i.e. part (b) of the group.

Table 1 takes the sector purpose codes which are likely to target MNCH and, within that, disburse aid to children under the age of five years old. These purpose codes were agreed upon by the G8 Health Working Group at the Muskoka Summit. Using updated information, this Report considers what share of these purpose codes are likely to be specific for MNCH and for children under the age of five years old, together with the a more detailed understanding of how these figures were arrived at.

There were four categories that the Muskoka Methodology used to come up with imputed percentages of what portion of aid was disbursed to RMNCH (G8, 2010). We use these assumptions for this paper, but update the figures which these assumptions were based on – namely the most up-to-date data on population and global burden of disease:

1. Activities that entirely or mostly targeted women of reproductive age and/ or children under the age of 5 (imputed percentage = 100%): When activities are almost exclusively for women of reproductive age and/ or children under the age of five an imputed percentage of 100% has been applied. When considering just children under the age of five, the methodology has assumed an imputed percentage of 30% which is what the 0-5 age group is as a share of the women of reproductive age and children under the age of 5. (Purpose codes: 12240 Basic Nutrition, 13020 Reproductive Health Care, 13030 Family Planning, 13081 Personnel Development for Population and Reproductive Health)

2. Activities which target the general population (imputed percentage = 33%): Health activities which target the entire population meant that the method imputes what part of these sectors goes to (a) women aged between 15 and 44 of reproductive age – 23% of the population and (b) children under the age of 5 – 10% of the population. This has been calculated using UN population data for 2015. (Purpose codes: 12110 Health Policy and Administrative Management, 12181 Medical Education/ Training, 12191 Medical Services, 12220 Basic Health Care, 12230 Basic Health Infrastructure, 12250 Infectious Disease Control, 12261 Health Education, 12281 Health Personnel Development, 13010 Population Policy and Administrative Management)

3. Disease-specific DAC codes (imputed percentage = various): Imputed DAC codes to a percentage which is consistent with the proportion of death from the proportion of death from diseases relating to malaria, tuberculosis and AIDs occurring in (a) children aged 0-4 years and (b) women aged between 15 and 49 years[i] based on the World Health Organisation’s Global Burden of Disease for the year 2015.(Purpose codes: 12262 Malaria Control, 12263 Tuberculosis Control, 13040 STD Control including HIV/AIDS)

4. Basic drinking water supply and sanitation (imputed percentage  = 10%): The primary purpose of basic drinking water supply and sanitation services are activities whose primary purpose is to prevent against gastro-intestinal infection and diarrhoea. Since diarrhoea is the second leading cause of under-five mortality, but not a major cause of maternal mortality the Muskoka Methodology considered basic drinking water supply and sanitation as health programs targeting primarily under-five children and imputed a percentage of 10% based on the demographic weight of this population. (Purpose Codes: 14030 Basic Drinking Water Supply and Basic Sanitation, 14031 Basic Drinking Water Supply, 14032 Basic Sanitation)

While the Muskoka Methodology identified purpose codes which were most likely to target aid to RMNCH, for a selected number of donors the Methodology did not consider this appropriate and a separate methodology was used to impute percentages to these donors entire aid portfolio in relation to what was assumed they gave to RMNCH. This paper has separated these donors, and tried to update some of the assumptions based on the most up-to-date information as indicated in Table 2.

In 2010 the G8 Health Working Group, when finalising the Muskoka Methodology got multilateral agencies and initiative to identify what part of their spending was for MNCH-related activities. Using 2009 spending as a baseline, this was used to apportion a share of their spending which was relevant to MNCH spending.[ii] For the purposes of this report, the following method has been applied:

1. GAVI: GAVI’s mission is to ensure that children under the age of 5 in developing countries are fully immunised and vaccinated. This report assumes that 100% of the funds that GAVI disbursed are used to benefit children under the age of five years old
2. GFTAM: Aid disbursements from the Global Fund to Fight Aids, Tuberculosis and Malaria (GFTAM) are used to target these three diseases. This report has taken the proportion of death from these diseases which occur in (a) children aged 0-4 years and (b) women aged between 15 and 49 years[iii] based on the World Health Organisation’s Global Burden of Disease for the year 2015. We apply this to the share of aid GFTAM disburses.
3. World Health Organisation: This report has taken the proportion of deaths from all diseases which occur in (a) children aged 0-4 years and (b) women aged between 15 and 49 years[iv] based on the World Health Organisation’s Global Burden of Disease for the year 2015. We apply this to the share of aid which the World Health Organisation disburses.
4. Regional Development Banks, UNFPA, UNICEF, World Bank and World Food Programme: The report takes the proportions that these donors reported as being what they disbursed to MNCH for the Muskoka Summit based on their 2009 aid disbursements. To then estimate what is going to children aged under five years old, the Report took the percentage of MNCH identified in the 2017 Lancet study which was specific to child health (Grollman et al., 2017).

In addition to health, nutrition and sanitation this report has also added what donors disburse to pre-primary ODA. Given the overwhelming majority of this will benefit the 0-5 population this is included in both the totals for RMNCH ODA and that which is disbursed to 0-5 year olds.

In 2017, the London School of Hygiene and Tropical Medicine (LSHTM) analysed ODA disbursements from a dataset containing 2.1 million records sourced from the OECD Creditor Reporting System. The objective was to create  a dataset to estimate ODA disbursements to reproductive, maternal, newborn and child health (RMNCH) based upon donor, recipient country and activity type between 2003 and 2013. The coding scheme devised by the LSHTM team classified records according to the degree to which they  promoted the attainment of the MDGs relating to reproductive and sexual health, maternal and newborn health, child health and prenatal health (Grollman et al., 2017).

The dataset has been utilised for this paper by estimating the part of RMNCH aid identified for the 2010 Muskoka Conference for particular multilateral donors (AfDF, AsDF, IDB Special Fund, , UNFPA, UNICEF, World Bank and World Food Programmes) which is specific for children aged 0-5 years old (see Table 2). This has been done  by applying the share identified by the Muskoka Methodology with the % of RMNCH aid identified specifically for Child Health in 2013 by the LSHTM Countdown ODA+ dataset:

e.g. the Muskoka Methodology identified that 5% of the World Bank’s ODA was disbursed to RMNCH. To identify the part specific for children aged under the age of five years old, the Report took the LSHTM Countdown ODA+ dataset and identified that 66% of World Bank’s RMNCH aid was for child health. This meant that in total we assume 3% of World Bank’s ODA’s is for children aged 0-5 years old (5%*66%)

[i] Age brackets under the Global Burden of Disease groups the age group 30-49 – this slightly extends the reproductive age we have taken as an example which ends at 44.

[ii] As part of this process G8 members applied these imputed percentages to their multilateral core contributions in order to identify the portion of their multilateral disbursements which was relevant to MNCH. However, for the data analysis for this paper, it should be made clear that the percentages identified in Table 2 have been applied to the funds that these multilateral organisations receive in “unearmarked funding” only. Earmarked funding is reported against bilateral donor disbursements under the OECD Creditor Reporting System; for these resources, therefore, the imputed percentages from Table 1 have been used.

[iii] Age brackets under the Global Burden of Disease groups the age group 30-49 – this slightly extends the reproductive age we have taken as an example which ends at 44.

[iv] Age brackets under the Global Burden of Disease groups the age group 30-49 – this slightly extends the reproductive age we have taken as an example which ends at 44.