In collaboration with PMNCH’s Ready, Set, Implement series and Africa Renaissance
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Health ministers have made the moral case for maternal and child health for decades. At this session, it was finance ministers and continental regulatory heads who made the case that mattered most: that failing to fund maternal and child health is not only a moral failure, it is a costly economic one.
The return-on-investment figures told the same story from every angle, even though the studies behind them approached the question differently: investing in maternal and child health pays for itself many times over. Here are the three headline estimates cited during the session, and what each one is measuring.
UNFPA
$8 per $1
Family planning and maternal health spending specifically
WHO global strategy
10x return
Plus an estimated $100bn in demographic dividends
PMNCH investment case
$20 per $1
Broadest RMNCAH investment case, the figure most cited in the room
The range reflects what each study counts as a “return” — UNFPA is narrowly scoped to family planning outcomes, while PMNCH’s figure factors in the fuller economic effects of a healthier, better-educated workforce over time. But even on the most conservative measure, every dollar spent returns eight — a case few other lines in any government budget can make.
A separate line of research put a price tag on inaction, and it is a stark one. A study by Madisi and colleagues found that a $3.2 billion intervention package, left unfunded, costs the world roughly $278 billion a year in lost benefit — a gap of more than eighty-fold between the price of acting and the price of not acting. The same research estimated that maternal and newborn deaths alone drain low-income economies of about 5% of GDP, a scale of loss usually associated with a major economic shock rather than a policy gap.
UNICEF’s Dr. Alex Adjagba argued that the obstacle to funding is translation rather than evidence. Health economists present figures denominated in DALYs averted and lives saved, the standard currency of global health, while finance ministries work in fiscal returns and growth multipliers — two audiences making the same argument in languages the other doesn’t use for budgeting. Africa CDC’s Dr. Raji Tajudeen made a related point about political will: in 25 years, only three African countries have consistently hit the Abuja Declaration’s 15%-of-budget target for health, despite the underlying evidence being available for most of that period. That gap, he suggested, is not one of knowledge. It is one of accountability.
Eswatini’s finance minister, Neal Rijkenberg, who chairs the AU’s finance committee, addressed the group as a budget-holder rather than a health advocate. He warned that treating RMNCAH as one line item among many leaves it exposed when budgets tighten, and argued instead for treating it as the highest-return line in the budget, which the figures above support. He connected this to declining aid: as external assistance falls, domestic budget decisions carry more weight, which he framed as a matter of sovereignty.
“Reproductive, maternal, newborn, child and adolescent health is not a cost center. It’s one of the highest return on investment items available to any of our governments.”
Two countries are already proving the model works. Ethiopia and Tanzania are the evidence base advocates need, and both are worth pulling apart figure by figure.
Ethiopia. Dr. Dereje Duguma described a financing model built almost entirely around domestic tools rather than external aid.
Maternal mortality, per 100,000 live births
700 → 141
Over the course of Dr. Duguma’s career in the sector
Compact agreement
$300M
Mobilized via 1:1 matching between government and ~11 partners
Insurance coverage
69M
People covered by community-based health insurance
Local manufacturing
40% → 60%
Share of maternal/child health commodities made domestically, current and targeted
The mortality drop is the headline, but the three figures above are the mechanism behind it: the compact agreement funds commodities for three to four years at a stretch rather than year to year, the insurance scheme spreads the cost of care across a much larger population than government revenue alone could cover, and the manufacturing target reduces exposure to import disruptions and currency shocks — the kind of shock that hit RMNCAH supply chains hardest during recent aid cuts.
His summary line was that health sovereignty requires financial sovereignty.
Tanzania. Deputy Health Minister Dr. Florence Samizi described a comparable shift, achieved through different mechanisms.
Health budget
$1B → $1.3B
Growth over two years, 2023/24 to 2025
Domestic backfill
$55M
Mobilized to cover a US assistance shortfall
Maternal mortality
-80%
Reduction credited to sustained domestic investment
The $55 million figure is the most instructive of the three: it isn’t new money in the abstract, it’s the specific amount Tanzania moved from its own budget to replace a US funding cut, in the same fiscal year the cut happened. That’s the “domestic resource mobilization” argument other speakers made in the abstract, shown as a completed transaction.
She credited President Samia Suluhu Hassan’s leadership, recognized through her appointment as the AU’s RMNCAH champion, with the improvement, and issued a direct appeal to finance ministers to maintain public-private partnership policy in order to support local manufacturing.
The African Medicines Agency’s Dr. Delese Mimi Darko addressed a different risk: that money spent on medicines and vaccines is wasted if the products themselves aren’t reliable.
Before regulation
83%
Of tested oxytocin found substandard in one market
After regulation
<2%
Same product, after regulatory monitoring introduced
Regulatory capacity
9 of 18
WHO-rated “stable and well-functioning” agencies globally that are African
Oxytocin is the drug used to stop dangerous bleeding after childbirth — a substandard batch doesn’t just fail to help, it can fail at the exact moment it’s needed most. The near-total drop after monitoring shows the problem was never a lack of capacity: nine of the world’s best-rated regulatory agencies are already African. Darko’s argument was that the gap is coordination across 55 separate national systems, not a shortage of technical skill. The fix, she implied, is political, not technical.
She pointed to slower African access to Covid vaccines, compared with Europe’s faster rollout through its single continental agency, as proof of what fragmentation costs in a crisis.
Closing the session, Caroline Kwamboka of African Renaissance Trust delivered the sharpest line of the day: the commitments governments need are not missing, they are already signed. The 8th session of the AU’s finance committee agreed months ago to higher budget allocations, health taxes, stronger public financial management, costed benefit packages, and blended finance instruments. What is missing is follow-through — turning those commitments into budget lines, tax legislation, and financing instruments before the next crisis exposes the gap. Two venues will test whether that happens: an Extraordinary Summit in Accra, and the next session of the Finance STC. Advocates will be watching both.
