Fund health systems, not projects, say researchers

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[LONDON] Investment in health systems — not just in specific health intervention projects — is key to achieving the Millennium Development Goals (MDGs) on maternal and child health, say experts.

The ‘Countdown to 2015’ initiative — which tracks progress in reducing child and maternal deaths under the MDGs — cites Tanzania as an example of a country that manages its health investment well.

The initiative highlights a study published in a special issue of The Lancet last week (10 April) showing that Tanzania is on track to hit the fourth MDG — to reduce mortality in children under five years old by two-thirds from 1990 to 2015.

Researchers in Tanzania calculated the annual death rates in children under five between 1990 and 2004, finding a decrease of 40 per cent, with the sharpest decrease (24 per cent) occurring between 2000 and 2004.

The heath service in Tanzania improved vastly between 1999 and 2004, they say. Policy changes led to a doubling of government spending on health. Donor and government funds were also pooled to create a ‘basket fund’ for redistribution in individual districts, providing additional funds per person.

This decentralisation allowed the scaling up of key interventions such as provision of insecticide-treated bednets against malaria infection, vitamin A supplementation against blindness and oral rehydration therapy against diarrhoea.

Tanzania is one of only a handful of countries to request that donors give funds to their general budget rather than to specific health projects, such as immunisation programmes. The country itself can therefore decide how to spend the money.

Only two per cent of donor money to maternal and child health is given in this way, according to the Countdown initiative.

"[Tanzania’s success] is because the government has taken charge and changed their policies. Through this approach they’ve actually got a much more reliable source of support," said Liz Mason, director of the Department of Child and Adolescent Health and Development at the WHO, speaking at the launch of The Lancet special issue on maternal and child health in London, United Kingdom, last week (10 April).

"We need a balanced focus and effort in investment in what are sometimes called ‘vertical interventions’ — such as vaccination and immunisation — with investment in strengthening the health systems," said Ann Starrs, president of Family Care International, a US-based non-profit organisation working to improve maternal health.

But, she adds, it’s not a matter of diverting money away from projects. "We need the whole [financial] pie to grow. And then we need the investments in the projects to be met by the health system. Ask any minister of health and that’s what they’ll say."

Less than a quarter of priority countries — those that account for 97 per cent of all maternal and child deaths — are on track to meet the MDGs on maternal and child deaths, says Countdown to 2015. This will be discussed in their report, due to be launched in Cape Town, South Africa, this week (16 April).

Link to full paper in The Lancet*

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