Trends In The Alignment And Harmonization Of Reproductive, Maternal, Newborn, And Child Health Funding, 2008-13.

Donor financing to low- and middle-income countries for reproductive, maternal, newborn, and child health increased substantially from 2008 to 2013. However, increased spending by donors might not improve outcomes, if funds are delivered in ways that undermine countries' public financial management systems and incur high transaction costs for project implementation. We combined quantitative and qualitative methods to examine the quality of funding for reproductive, maternal, newborn, and child health globally and in Tanzania, based on two principles of aid effectiveness: the alignment of donor financing with the recipient country's public health financial management systems, and donor harmonization for coordinated, transparent, and collectively effective actions. We found that alignment of donor financing deteriorated throughout the period, with the proportion of funds channeled through governments decreasing from 47 percent to 39 percent. Tanzania-based donors attributed the change to the pressure donors were under to achieve and show results. Donor harmonization was low overall and remained relatively constant, although it increased in sub-Saharan Africa and decreased in South Asia. Bilateral funding agencies were the most harmonized donors. We recommend that future assessments of Sustainable Development Goals financing include measures of harmonization and alignment of funding.