Research Purpose and Objectives

1. Tracking Official Development Assistance for Reproductive Health in Conflict-Affected Countries: 2002 to 2011 Preeti Patel1, Maysoon Dahab2, Mihoko Tanabe3, Lydia Ettema4, Samantha Guy5 and Bayard Roberts6 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

2. Research Purpose and Objectives Purpose: To provide longer-term trends in patterns of ODA disbursement for RH activities in 18 conflict-affected countries from 2002 to 2011 Objectives • To measure absolute & per capita amount of RH ODA to 18 conflict-affected countries • To compare RH ODA disbursed to conflict-affected countries and non-conflict affected countries • To analyse disbursement patterns of RH ODA across different RH-related activities • To analyse disbursement patterns of RH ODA across donors

3. Methodology Data Source • Creditor Reporting System (CRS) maintained by Development Assistance Committee (DAC) of the Organisation of Economic Cooperation and Development (OECD) • http://stats.oecd.org/Index.aspx?datasetcode=CRS1 • 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

4. 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 2000-2009 (Uppsala definition) so includes post-conflict

5. Data Analysis • CRS data for 2002-2011 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’

6. CRS activities included [

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

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

9. 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)

11. Results: Objective Three

12. 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 2009-2011: $2.88 million - average annual RH ODA per capita = $0.000002

13. 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

14. Key messages • Substantial increase (298%) in ODA funding for reproductive health activities to the 18 conflict-affected countries between 2002 and 2011. • Majority of the increase in overall reproductive health funding is explained by increased ODA for HIV/AIDS activities • Inequity in funding between conflict-affected countries – winners and losers • Inequity in funding between conflict-affected countries and non-conflict-affected least developed countries – conflict-affected countries losing out • Gates funding for reproductive health for conflict-affected countries is negligible • $1.93 per person per year seems very low but we don’t know what the funding gap is? • Need for detailed analysis of in-country RH ODA expenditure – who is benefitting? • Need to better understand the relationship between ODA investment and changes in RH outcomes

15. References Patel, P., et al., Tracking official development assistance for reproductive health in conflict-affected countries. PLoS Med, 2009. 6(6): p. e1000090. Patel, P. and B. Roberts, Aid for reproductive health: progress and challenges. Lancet, 2013. 381(9879): p. 1701-2. Patel, P., et al., A review of global mechanisms for tracking official development assistance for health in countries affected by armed conflict. Health Policy, 2011. 100(2-3): p. 116-24. 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, 2009. 6(6): p. e1000093. Hsu, J., P. Berman, and A. Mills, Reproductive health priorities: evidence from a resource tracking analysis of official development assistance in 2009 and 2010. Lancet, 2013. 381(9879): p. 1772-82. Warsame, A., P. Patel, and F. Checchi, Patterns of funding allocation for tuberculosis control in fragile states. Int J Tuberc Lung Dis, 2014. 18(1): p. 61-6.