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# _IV. CONCLUSIONS_

# A. _S tlig*W Mehods_

Ideally, each country and region should keep data on the costs of direct and<sup>indir</sup> programs to improve maternal health. Although mortality, morbidity, accessibility,<sup>and service data a -available</sup> on a country-by-country basis, there is limited information on financial<sup>flows at the country level.</sup> Budget and accounting procedures most often follow traditional expenditure<sup>categories rather than</sup> disaggregating funds by program. This has made it extremely difficult<sup>to calculate support for targeted</sup> activities. Unless statistical and accounting methods are improved, the supply<sup>of funds to maternal</sup> health activities will continue to be measured by attributing a certain percentage<sup>of the project to these</sup> programs. At the country level, this task calls for a statistical training program<sup>for government and</sup> non-government staff. For external financial sources, the problem is different.<sup>In contrast to the</sup> specific maternal health orientation of health organizations, bilateral and multilateral<sup>donors vary in</sup> their perceived need for maternal health data. Dcvelopment organizations<sup>are primarily zountry- or</sup> region-oriented. Consequently, specific health expenditures place additional<sup>demands on their statistical</sup> systems.

Although the principal donors have been exceptionally cooperative in estimating<sup>expenditures</sup> for this study, donor data are unlikely to serve as the most precise source of information<sup>on financial</sup> flows. It is at the country level that the relevant financial information -- the<sup>level of financing</sup> negotiated in relation to the level of maternal risk -- will be maintained.

The factors that influence maternal health have been well-defined by Herz and Measham (1987). The use of arbitrary percentages in this paper is useful only as a starting<sup>point for future refinement.</sup> As better measures and criteria are identified, it should be feasible to improve<sup>the measurement of</sup> expenditures that contribute to risk reduction hout relying on an extended multisectoral definition of safe motherhood. While it is true that direct and indirect benefits are the result of<sup>general development</sup> activities, not every component has the same effect. Some donors<sup>maintain that family planning and</sup> primary health care -- in combination with general development programs -- are a sufticient and appropriate approach to reducing maternal mortality. Other donors recognize<sup>the explicit need to</sup> address the risks and complications of pregnancy as the causes of mortality and morbidity,<sup>and point out</sup> that these risks will continue to exact high mortality rates unless donors intervene<sup>with targeted 'core'</sup> programs. To encourage international financing, to cooperate with developing countries<sup>in more</sup> targeted programs, and to provide a better tool for program and<sup>financial measurement, the Meeting of</sup> Interested Parties will need to sharpen the definitions and strategy of the<sup>Initiative.</sup> Such measurements become particularly important in justifying<sup>and mobilizing financing for</sup> maternal health. How is this task to be accomplished? The issue<sup>is a suitable topic for the agenda of</sup> the Meeting of Interested Parties. More specifically, the issue is how<sup>the Initiative co-sponsors can offer</sup> professional and financial resources to developing countries to help define<sup>financial flows and to</sup> accelerate a more targeted program to reduce maternal risk.

# _B. Fimu4ial Truws._

For the 17 major bilateral sources, including the European Community, funds<sup>for SM programs</sup> increased (in current dollars) from S691.5 million in 1986 to S818.8 million<sup>in 1988 (see Figure 1).</sup> Approximately half of this amount was for so-called core activities,<sup>primarily family planning services</sup> (see Figure 2). General health, population, and nutrition sector flows for the same<sup>period increased</sup> from an estimated 32,221 million to S2,863.6 million. These trends<sup>were positive for 13 sources,</sup> unchanged for three, and negative for one.