global financing facility (gff) in support of every woman every child workshop – day 2 –...
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Global Financing Facility in supportof Every Woman Every Child
Investing for RMNCAH results
2
The big picture: what are we trying to accomplish?
• Smart financing: improving efficiency by approximately 15% in 2030• Scaled financing: crowding-in domestic resources and attracting new
external support – mobilizing a cumulative total of >US$57 billion between 2015 and 2030)
3
What do we need to focus on?
• Implementation challenges: Implementation barriers and evidence-based strategies to overcome them for achieving results especially for groups such as adolescents, urban slum dwellers, or rural women
• Maximizing the returns on investment: Agreeing and aligning on a set of priorities that can be implemented given the resources available (while mobilizing additional resources)
• Smarter, scaled, and sustained financing: Addressing the fact that financing for RMNCAH has been characterized by gaps, overlaps, and funding for areas outside of national priorities
Acceleration of results
4
Why do we need an Investment Case: theory of changeN
ation
al st
rate
gic
fram
ewor
k(s)
Investment Case
Government
Donor 1
Donor 2
GFF Trust Fund +
IDA/IBRD
Gavi, Global Fund, other multilateral
Priv
ate
sect
or
Donor 2Donor
1
Donor 3
Private sector
Government
The Investment Case aims to drive agreement among key stakeholders on a set of priorities that can feasibly be implemented given the resources available, and then to shape the financing of such priorities
5
Scope of Investment Cases
Clinical service delivery and preventive interventions
Health systems strengthening
Multisectoral approaches
End preventable maternal and child deaths and improve the health and quality of life of women, children, and adolescents
Serv
ice
deliv
ery
appr
oach
es
CRVS
Equity, gender, and rightsMainstreamed across areas
• Prioritizes interventions with a strong evidence base demonstrating impact• Emphasizes issues (e.g., family planning, nutrition) and target populations (e.g.,
adolescents) that have been historically underinvested in• Further focuses on improved service delivery to ensure an efficient national
response (e.g., through task-shifting, integration of service delivery, community health workers, private sector service delivery environment)
Investment Caseroad-map
• Roles• Timeline• Milestones• Potential TA
needs• Agreement
on country platform
Core analytics
• Equity• Sub-national
differences• Efficiency• Multisectoral
determinants• Upcoming
structural shifts
Costed options and resource map
• Costed set of interventions and strategies (including multisectoral components)• RMNCAH
resource landscape by program, location and partner
Prioritized Investment Case
• Set of priority interventions/strategies that fit within available resources• If appropriate,
scenario analysis with different sets of interventions and strategies based on different scenarios of resource availability• Results framework
with plans for monitoring and evaluation
Commitments and alignment to Investment Case
• High level agreement on co-financing between government and partners, and within government between ministries of health and finance
Costing, cost-effectiveness, and resource
mapping
Approach to Investment
Case development
Impl
emen
t
Core set of interventions and strategies
• Agreement on 2030 targets and 5 year milestones• Identification of
priority high-impact interventions• Core strategies
to address system bottlenecks • Multi-sector
interventions including CRVS
Overview of process and outputs towards a quality Investment Case
Results and key interventions and strategies
Agreement on repartition of financing for
the Investment Case
Core analytics
Prioritization and maximization of
returns on investment
6
7
Key issues: core analytics
• Significant improvements in recent years – many countries more analytical in assessments of changes in epidemiology and in coverage
• GFF brings sharper focus on:– Equity– Sub-national differences– Efficiency– Multisectoral determinants– Upcoming structural shifts (e.g., economic growth,
urbanization, demographic changes, climate change)
8
Key issues: results and key interventions and strategies
• GFF approach:– Definition results that a country wants to achieve over the
longer term– Mix of interventions and service delivery modalities that are
appropriate for the epidemiological context– Focus on core systemic bottlenecks and inefficiencies, including
identifying long-term transformational initiatives– If appropriate given core analytics, multisectoral investments
(including CRVS)
9
Key issues: costing, cost-effectiveness, and resource mapping
• Improvements in costing in recent years, but cost-effectiveness not systematically assessed and resource mapping efforts uneven
• GFF approach:– Costing based on existing approaches in use– Effectiveness should be quantified to the extent possible– Resource mapping should include fiscal space analysis (but idea
is not an exhaustive exercise -> practical, rough estimates for to guide decision-making)
10
Key issues: prioritization
• Limited progress in many countries• GFF approach:
– Investment Case should contain prioritized set of interventions and strategies that can be implemented within resource envelope
– Scenario planning may be useful, given uncertainties about resource availability and desire to include “full need” scenario
• GFF brings sharper focus on:– Optimizing inputs: focus on efficiency gains– Maximizing outcomes: cost-effectiveness analysis– Addressing the specific health needs of vulnerable groups:
identification and targeting
11
Key issues: agreement on repartition of financingIn
vest
men
t Cas
e
Government
Donor 1
Donor 2
GFF Trust Fund +
IDA/IBRD
Gavi, Global Fund, other multilateral
Priv
ate
sect
or
Repartition of financing will not occur automaticallyTwo key processes: dialogue between MoH and MoF, and among external financiers
1. Key issue is institutionalization of priorities, particularly through budgets and MTEFs; requires sustained dialogue between MoH and MoF, facilitated by analytical work that will speak to MoF concerns; GFF can support that through a range of mechanisms (next slide)
2. A number of key donors (e.g., USAID, JICA, DFID, Canada, Norway, Gavi, Global Fund) have expressed willingness to support Investment Cases, but achieving this requires sustained dialogue at the country level (ideally both through government-donor dialogue and among donors)
12
What lessons learnt and need to be learnt?
• Country platform• Inclusion of previously neglected program areas and
population groups• Prioritization• Technical assistance• Quality assurance• Relationship with implementation
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