09/20/2011 02:57 EDT | Updated 11/19/2011 05:12 EST

Poorest countries investing more as UN states meet pledge for maternal, child health

Bangladesh, Ethiopia, Nepal and some of the world's other poorest countries helped lead the way over the past year as U.N. member states began meeting their unprecedented pledge of more than $40 billion for maternal and child health, a new study of the spending says.

The spending report is being released Tuesday at a high-level event chaired by U.N. Secretary-General Ban Ki-moon, who has made raising money for the health of mothers and their children a pet project.

"By and large, the commitments made have been met," said Dr. Julio Frenk, chairman of the fundraising effort and dean of the Harvard School of Public Health.

Frenk, chairman of the World Health Organization's Partnership for Maternal, Newborn and Child Health and a former health secretary of Mexico, said he was especially pleased to see that some of the poorer nations are taking on more financial responsibility for their development needs.

Those countries are "moving away from the paternalistic to a framework for shared accountability," said Frenk. "The leadership shown by the lowest-income countries in their commitments to improve women's and children's health has been outstanding."

Frenk said that close to $45 billion has been committed to the U.N. initiative known as Every Mother Every Child, passing the initial pledges of $40 billion made a year ago. That includes about $11 billion from the world's poorer countries, and $13.7 billion from high income governments including the United States, Britain, Canada and Norway.

"I am delighted by the progress since last year," said pediatrician Dr. Flavia Bustreo, WHO assistant director-general for family, women's and children's health. She added that commitments have included not only money, but changes in policy and delivery of services.

Bustreo said more still needs to done to treat severe infections in newborns and increase postnatal visits by mothers and babies. Up to 1 million more "front-line" health workers, especially midwives, are needed to care for mothers and their babies around the world, she added.

The report shows that Bangladesh and many of the other poorer countries that made pledges last year set aside more funds for better health care of mothers and small children within their borders as they take more responsibility for their own development.

Some of those poorer countries also made major policy changes. Bangladesh said it would train 3,000 midwives and double the percentage of births in the country attended by a skilled health worker. Nepal began training 10,000 more skilled birth attendants.

Frenk said the collective effort is critical to meeting the U.N.'s global goal of saving the lives of 16 million mothers and children by 2015.

Worldwide every year, an estimated 8 million children die before reaching their 5th birthday, and about 350,000 women die during pregnancy or childbirth.

In 2000, the U.N. set "Millennium Development Goals" that included reducing child mortality by two-thirds and maternal mortality by three quarters by 2015. The goals also included cutting extreme poverty by half, ensuring universal primary education, halting and reversing the HIV/AIDS pandemic.

During a three-day summit on those goals last September, there was skepticism that governments and non-profit agencies would be able to deliver all the $40 billion pledged for mothers and children amid a global economic crisis. The international aid organization Oxfam at that time publicly asked where they money would come from.

But Ban and other world leaders exhorted governments and private aid agencies to honour their commitments and not abandon the world's 1 billion people living on less than $1.25 a day.

On the eve of the Tuesday launch, the Secretary-General praised private companies for raising more than $1.1 billion for the initiative.

The companies include Johnson & Johnson, which is embarking on a four-year partnership with the World Health Organization, other U.N. agencies and the World Bank to strengthen training for health workers in Tanzania and Ethiopia.

"Companies are often treated with suspicion when they enter the realm of global development, but they are playing a central role in improving the lives of women and children," Ban said. "Every Woman Every Child has shown what can be achieved through close co-operation between the U.N., governments, and the private sector."

Another example of such co-operation is the GAVI Matching Fund for Immunization, a new private-public initiative in which Britain's Department for International Development and the Bill & Melinda Gates Foundation match private sector contributions to deliver critical vaccines to the world's poorest nations.

Among countries, India has made one of the biggest financial commitments, spending more than US$3.5 billion each year on health services, with specific efforts to focus on the districts accounting for most of the infant and maternal deaths.

The reports' authors suggest some special assistance may be needed in some poor nations that received no aid pledges at all, including North Korea, Sao Tome and Principe, the Solomon Islands and Yemen.

The report also mentioned that the African countries of Burundi, Djibouti, Equatorial Guinea, Central African Republic, Gabon, Madagascar and Togo had also received little support. Indonesia, the world's fourth most populous country, and the Philippines received very little help as well.