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maternal and child health programmes and institutional structures continue to be the object of strong donor commitment, as they have often been supported and built up by donors over many years. These programmes, however, still lack vertical accountability, which tends to perpetuate programme-specific flows of funding, management, commodities, logistics, reporting and so on. This “silo� funding and vertical orientation is contrary to stated donor and government policy goals to provide integrated service delivery and strengthen the long-term capacity and growth of the health sector, as agreed to in the Programme of Action. Despite all good intentions, such vertical approaches may have been exacerbated by the establishment of vertical funding mechanisms such as the Global Fund to Fight AIDS, Tuberculosis and Malaria (2000). 3.
Domestic expenditures 747. Domestically generated financial resources, which include government, national NGO and private out-of-pocket expenditures, account for the majority of funding for the costed components of the Programme of Action. Although much harder to measure, it is estimated that developing countries and countries in transition mobilized $54.7 billion for population activities in 2011, the largest amount ever. The considerable increase over previous years is due in part to the large expenditures reported for family planning in China, but the latest numbers may not be entirely comparable to past estimates owing to the inclusion of new data on out-of-pocket expenditures from WHO (see table 6).516 Table 6 Estimates of global domestic expenditures for four components of the Programme of Action, 2011 (Thousands of United States dollars) Source of funds
Region
Governments
NGOs
Consumers
a
Percentage spent on sexually transmitted Total diseases/HIV/AIDS
Africa (sub-Saharan)
3 244 374
119 916
3 567 490
6 931 780
95%
Asia and the Pacific
11 249 700
157 910
27 944 254
39 351 864
10%
2 190 262
80 799
1 133 654
3 404 715
85%
542 511
60 014
349 920
952 445
36%
2 669 365
16 025
1 374 723
4 060 113
96%
19 896 212
434 664
34 370 040
54 700 916
32%
Latin America and the Caribbean Western Asia and North Africa Eastern and Southern Europe Total
Source: UNFPA, Financial Resource Flows for Population Activities in 2011 (New York, 2013). See also Erik Beekink, Projections of Funds for Population and AIDS Activities, 2011-2013 (The Hague, Netherlands Interdisciplinary Demographic Institute, 2013). a Consumer spending on population activities covers only out-of-pocket expenditures and is based on the average amount per region measured by WHO for health-care spending in general. For each region, the ratio of private out-of-pocket to per capita government expenditures was used to derive consumer expenditures in the case of population activities.
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