Abstract
BackgroundSignificant levels of funding have been provided to low- and middle-income countries for development assistance for health, with most funds coming through direct bilateral investment led by the USA and the UK. Direct attribution of impact to large-scale programs funded by donors remains elusive due the difficulty of knowing what would have happened without those programs, and the lack of detailed contextual information to support causal interpretation of changes.MethodsThis study uses the synthetic control analysis method to estimate the impact of one donor’s funding (United States Agency for International Development, USAID) on under-five mortality across several low- and middle-income countries that received above average levels of USAID funding for maternal and child health programs between 2000 and 2016.ResultsIn the study period (2000–16), countries with above average USAID funding had an under-five mortality rate lower than the synthetic control by an average of 29 deaths per 1000 live births (year-to-year range of − 2 to − 38). This finding was consistent with several sensitivity analyses.ConclusionsThe synthetic control method is a valuable addition to the range of approaches for quantifying the impact of large-scale health programs in low- and middle-income countries. The findings suggest that adequately funded donor programs (in this case USAID) help countries to reduce child mortality to significantly lower rates than would have occurred without those investments.
Highlights
Significant levels of funding have been provided to low- and middle-income countries for development assistance for health, with most funds coming through direct bilateral investment led by the USA and the UK
To better describe here United States Agency for International Development (USAID)’s approach to child mortality reduction, we reviewed USAID’s annual Reports to Congress on the Child Survival and Health Programs Fund from 2001–2004 as these were the early years of Integrated Management of Childhood Illness (IMCI) and the Millennium Development Goals (MDG) [22,23,24,25]
With the exception ‘Predictor year range,’ all RSMPE were generated with pretreatment period 1980–1998 four or more antenatal care visits were removed by the model optimization to achieve the minimal difference between the treatment and control in the pre-intervention period
Summary
Significant levels of funding have been provided to low- and middle-income countries for development assistance for health, with most funds coming through direct bilateral investment led by the USA and the UK. Close to $600 billion of development assistance for health (DAH) was provided between 1995 and 2018 [1]. Weiss et al Population Health Metrics (2022) 20:2 was estimated at $38.9 billion with the majority of funds coming through direct bilateral assistance, with the USA leading at 34% of total DAH followed by the UK at 8.4%. Single-year estimates of DAH for reproductive, maternal and child health vary by source with estimates ranging from $10.8 to $13.1 billion, with the USA consistently as the single largest contributor across sources [3]
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