Global Fund New Funding Model
– How to Achieve Impact: Health
Systems Strengthening
Katja Rohrer, Department of Health System Governance and Financing
19 June 2014
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How to Achieve Impact: Health Systems Strengthening | 16 June 2014
Consideration of crosscutting issues:
How can funding from the Global
Fund contribute towards
strengthening health systems?
Concept note development
1. Concept notes should be derived from the government's
health policies / strategies / plans
2. The health system building blocks can serve as a guide to
areas for investment
3. Strong proposals clarify the links and coherence between
the content of the proposal and
•
•
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National policies / strategies / plans
Other planned or current funded activities in the same area
How to Achieve Impact: Health Systems Strengthening | 19 June 2014
What happens if investments are not
based on a sound national health plan
 Extra burden on government to manage many partners
 Creation of complexity in systems and procedures
 Distortion of incentive systems and undermining of
government leadership
 Unbalanced investment
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How to Achieve Impact: Health Systems Strengthening | 19 June 2014
Extra burden on government to manage
many partners
Multilateral agencies
State and Parastatal organisations
Gavi
BAD
IMF
World bank
53 specialised
programs
UNFPA
UNAIDS
13 MoH
Departments
WHO
Global Fund
UNICEF
Ministry of
Finance
IHP+
WFP
UNHCR
Fonds Social de
la République
Schools of
Public Health
11 Provincial
Faculties of
Ministries of Health Medicine
11 provincial
management
team
Ministry of
Education
BCECO
Bilateral Funding / Technical agencies
EU
MOH
(15 Staff)
13 Donor Government program
coordination committees
BTC CTB
USAID
ACDI
GTZ
VVOB
SIDA
Apefe
DFID
Salvation
army
ECHO
BASICS
MSF
Belgium
Merlin
PSF-CI
Memisa
Louvain
development
Fometro
Cemubac
CRS
INGO's (Emergency)
Caritas
Damian
Foundation World
Vision
Sanru
ECC
BDOM
Asrames
Cordaid
Novib
Oxfam
GB
More than 200 health partners
[Source: Porignon, WHO, 2008]
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How to Achieve Impact: Health Systems Strengthening | 19 June 2014
Int and Nat NGO's (Development and church related)
Creation of complexity in systems and
procedures
Procurement systems - Kenya
Source: Kinzett, 2007
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How to Achieve Impact: Health Systems Strengthening | 19 June 2014
Distortion of incentive systems and
undermining of government leadership
Cambodia salaries
Viet Nam salaries
1,800
1,200
900
50-100
MoH
•
•
•
•
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100150
DFID
800
500
250-400
WB
50-200
GF*
MoH salaries $50-100 per month
DFID health worker incentives in
HIV/AIDS program; WB programs with
significantly higher pay in overlapping
districts where “poaching” will occur
GF granted PR (MoH HIV/AIDS
program) salary request of $900 per
month for program managers
Donor practices lead to escalating
distortion of salaries
and poaching of resources within
HIV/AIDS sector
How to Achieve Impact: Health Systems Strengthening | 19 June 2014
* Increase for program managers only of GFATM grants
MoH
•
•
•
•
•
DFID
GF Rd 4
GF Rd5
National
programs
MoH salaries $50 to few hundred
per month
CCM pays GF-associated employee
$1,200 per month
Round 5, CCM further escalating
salary cap ($1,200 + annual
increase)
National programs increase salaries,
resulting in major country-wide
salary inflation
“This has been phenomenally
destructive.”
Unbalanced investments
(25 LI countries)
ONE COUNTRY
HRH: Human resources for health
I&E: Infrastructure and equipment
L&M: Logistics and medicine (L&M)
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HIS: Health information systems
L&G: Leadership and governance
HFA: Health financing activities
How to Achieve Impact: Health Systems Strengthening | 19 June 2014
Impact on countries
• Fragmented funding and/or
funding outside the national
budget and plan
• Undermines government capacity
• too many proposals,
• too many meetings,
• too many monitoring demands
• Duplication of services and
supplies – or even competition
between projects and donors
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How to Achieve Impact: Health Systems Strengthening | 19 June 2014
• Waste of scarce
resources
• Inefficient use
funds
• Lack of country
leadership and
ownership
of
Health systems strengthening (HSS) in
Global Fund Strategy 2012-2016
Maximizing effectiveness of Global Fund investments in
HSS with the following priorities:
 Strategic targeting of HSS investments towards most-inneed countries and high-impact HSS interventions
 Better alignment, harmonization, and tracking of HSS
outcomes and impact
 Explicit provision for community systems strengthening
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How to Achieve Impact: Health Systems Strengthening | 19 June 2014
New Funding Model and HSS
 No specific HSS allocation in the country
envelope - for both options, HSS funds to be
requested from disease grants
“ …countries encouraged to consider system-related needs
across disease programmes during the country dialogue
and request funding for cross-cutting HSS”
 Option 1: Funding requests for eligible HSS
interventions within the disease concept note
 Option 2: Apply for HSS funds through a separate
concept note
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How to Achieve Impact: Health Systems Strengthening | 19 June 2014
For both options, what should this mean in
practice? (1)
 Consultative country dialogue with key stakeholders
 Three diseases work together in identifying systemic
issues affecting programme’s implementation and pool
resources to address challenges
 Long-term sustainability of the three diseases that can
deliver services in an integrated manner
 Alignment of disease programmatic plans to overall
national health sector strategic plan
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How to Achieve Impact: Health Systems Strengthening | 19 June 2014
For both options, what should this mean in
practice? (2)
 Clearly defined interventions; of a realistic scale, and credibly
costed
– Global Fund prioritizes a narrower scope of HSS investments (if
justified, funding requests outside these prioritized areas may be
considered):
 procurement and supply chain management
 health management information systems
 human resources for health
 service availability and accessibility
 financial management
 National system for monitoring and evaluation, based on the
health sector strategic plan
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How to Achieve Impact: Health Systems Strengthening | 19 June 2014
Some issues for consideration during the
concept note development
 Health systems interventions:
Strengthening health systems? or Supporting the health system?
 Programmes’ design and implementation aim is:
– Create a synergic environment where all programmes benefit
 Design of the NFM (pre-determined envelope per disease) may not always
encourage diseases to engage in an HSS dialogue / or an HSS cross
cutting stand-alone concept note - perception of “reducing” funding
allocations for the benefit of HSS;
 Experience in countries shows that the extent to which HSS is discussed
and included in the submissions depends often on goodwill of CCMs and
disease teams (meaning is not systematic); push from GF country teams is
important;
 Which entity has the expertise to plan, manage and implement cross-cutting
interventions?
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How to Achieve Impact: Health Systems Strengthening | 19 June 2014
Thank you