The saying “you can’t manage what you can’t measure” may be an oversimplified management concept, but it gets to the gist of why resource tracking in global health is important. Resource tracking is the monitoring of how country governments, donors and NGOs fund programs in any given health area — including tracking how much is being spent, where the money is going, and how the funds are used.
When resource tracking is done well, timely and accurate data is available to guide program planning and monitor spending. As a result, resource tracking can help strengthen health systems in the following ways:
- Ensure funds are spent effectively and efficiently. Policymakers and donors can assess whether they are investing in the right programs (program areas that are most cost-effective and impactful) in the right places (populations or geographic areas with the greatest need) using the right methods.
- Improve transparency and accountability. Resource tracking increases the transparency of government and donor spending by following how funding flows through various levels of government to the final point of service delivery. Resource tracking also allows advocates to hold policymakers and donors accountable for how public and donor funds are used, and monitor progress against spending commitments.
- Encourage stakeholders to step up commitments to health. Information on how much is currently being spent — coupled with strategic planning, cost estimation and impact analysis—can help build an investment case that encourages stakeholders to make financial commitments. Joint planning between stakeholders can improve programming and mobilize additional resources.
Challenges in tracking funding for nutrition
While methods for tracking broad health spending (e.g., National Health Accounts), and even spending for specific disease areas like HIV/AIDS (e.g., National AIDS Spending Assessments), have long been in use, resource tracking for nutrition is still a new and emerging field. Few tools exist to track nutrition investments besides the Creditor Reporting System (CRS) of the Organisation for Economic Co-operation and Development (OECD), which is the primary tool available to track global donor aid in all sectors.
As part of R4D’s nutrition financing work, we use the Creditor Reporting System to estimate how much donors are spending on nutrition. However, the system does not currently track nutrition funding in a way that meets the needs and priorities of the nutrition community. The nutrition community needs to estimate donor funding for two types of nutrition interventions: nutrition-specific and nutrition-sensitive. Nutrition-specific interventions are those that impact the immediate determinants of nutrition (e.g. adequate food and nutrient intake, feeding, caregiving and parenting practices), and are typically within the health sector. Nutrition-sensitive interventions are those that address the underlying determinants of nutrition, which often relate to sectors such as agriculture, education, and sanitation.
The Creditor Reporting System classifies nutrition under a tracking code (the basic nutrition code) that does not align well with the widely-accepted definition of nutrition-specific interventions. For example, school feeding programs currently fall within the basic nutrition code, even though school feeding is not a nutrition-specific intervention. School meals are rarely sufficiently diversified and fortified to provide the appropriate micronutrients, and these programs usually target children who are beyond the vital 1,000-day window (between a woman’s pregnancy and her child’s 2nd birthday) during which serious and irreparable damage caused by malnutrition can be prevented. In addition to not aligning well with the definition of nutrition-specific interventions, the Creditor Reporting System also does not have a mechanism in place to track multi-sectoral nutrition-sensitive interventions. As such, it is currently very difficult to track nutrition funding in a timely and accurate manner, which in turn impedes nutrition advocacy and coordination.
Looking to the future
To overcome these challenges in tracking funding for nutrition at the global level, R4D published a policy brief with recommendations for how the CRS could track nutrition funding in a way that better aligns with the needs and priorities of the nutrition community. The first recommendation is to ensure that what the CRS calls “basic nutrition” is aligned with the widely-accepted definition of nutrition-specific investments from The Lancet. The second recommendation is to create a policy marker that identifies nutrition investments across all sectors. A group of advocates led by Action Against Hunger will adapt these recommendations into a formal proposal to the OECD in Spring 2017 to improve how the CRS tracks funding for nutrition.
Additionally, as resource tracking improves at a global level, it is equally important to pursue country-level resource tracking of government and donor funding for nutrition, because country-specific data is a critical input when formulating national policy. R4D is an emerging leader in this space, having already completed a budget analysis for nutrition programs in the state of Rajasthan in India and assessed the gap between the needs vs. the available funding for nutrition in the state. In Ethiopia, R4D is working closely with the Ministry of Health to map multi-sectoral nutrition investments, with the purpose of helping ensure that current investments are aligned with priorities in the National Nutrition Plan and supporting the government’s efforts to end malnutrition by 2030.
Resource tracking can provide crucial data that country governments, donors and advocates need in order to efficiently use limited resources and maximize impact on nutrition. As funding for nutrition rises in accordance with the Global Investment Framework for Nutrition, it will be increasingly important to routinely track funding to improve transparency, accountability and, ultimately, timely planning and priority-setting for nutrition programs around the world.
Photo © Bartosz Hadyniak