GLOBAL FINANCING FACILITY
IN SUPPORT OF
EVERY WOMEN EVERY CHILD
Agenda
• The Need and the Vision
• What: Smart, Scaled, and Sustainable Financing for Results
• How: Key Approaches to Deliver Results
• Who: The Country Platform
• The GFF Trust Fund
• Governance
• Timeline
2
Agenda
• The Need and the Vision
• What: Smart, Scaled, and Sustainable Financing for Results
• How: Key Approaches to Deliver Results
• Who: The Country Platform
• The GFF Trust Fund
• Governance
• Timeline
3
Global momentum to accelerate progress in RMNCAH…
Under-five mortality rate
(per 1,000 live births)
100
Maternal mortality ratio
(deaths per 100,000 live births)
450
90
400
80
350
70
300
60
250
50
200
40
150
30
100
20
50
10
0
0
1990
1995
2000
2005
2010
2015
1990
1995
2000
2005
2010
• Reduction in <5 mortality rate: from 90 deaths per 1,000 live
births in 1990 to 46 in 2013 (40% are newborns)
• Reduction in MMR: from 380 deaths per 100,000 live births in
1990 to 210 deaths in 2013
• 11% of all births are to girls aged 15-19 years; complications
linked to pregnancy and childbirth second most common cause
of death
2015
4
…but challenges remain
• MDG 4 and 5 unfinished agenda
• Large remaining funding gap - significant additional
investments from both domestic and international
resources needed
• Equitable and sustained progress under threat as
countries transition from low- to middle-income status
• Inefficiencies in RMNCAH investments due to poor
targeting and fragmented financing
• Poor state of civil registration and vital statistics systems
(CRVS)
5
Increasing domestic resource mobilization is key to closing the gap
in financing for RMNCAH
RMNCAH financing needs in 63 low- and lower-middle-income Countdown countries
40
Remaining gap of US$4-8 billion by
2030, depending on government
prioritization of RMNCAH
35
Billions US$
30
25
20
Peak gap of US$25-27 billion per
year, of which ~US$11 billion is
covered by international
financing
Resource gaps
50% of gov't health expenditure
to RMNCAH
15
10
25% of gov't health expenditure
to RMNCAH
5
2015
2030
6
The GFF is part of a broader global effort
• Financing for Development agenda
• Development of the Sustainable Development Goals, with the
unfinished business of MDG‘s 4 and 5 being a key priority
• Dialogue amongst global financing institutions about
graduation and financial sustainability in the development
continuum
• Renewal of the Every Woman Every Child Strategy
7
The ultimate goal of the GFF is to drive achievement of the SDGs
End preventable deaths and improve the
quality of life of women, children and
adolescents by significantly scaling sustainable
investments in RMNCAH
Between 2015-2030, scale up in high burden countries
could prevent up to:
• 4 million maternal deaths
• 101 million child deaths
• 21 million stillbirths
8
Agenda
• The Need and the Vision
• What: Smart, Scaled, and Sustainable Financing for Results
• How: Key Approaches to Deliver Results
• Who: The Country Platform
• The GFF Trust Fund
• Governance
• Timeline
9
What: Smart, scaled, and sustainable financing for results
Focus on evidence-based,
high impact interventions
and results
Smart
Results
Scaled
Maintain RMNCAH
results through
domestic financing
Sustainable
Finance RMNCAH
at scale through
significantly
increased domestic
and international
financing
10
Smart: “best buy” interventions cut across sectors
Service delivery
approaches
End preventable maternal and child deaths and improve the health and quality of
life of women, children, and adolescents
Clinical service delivery and
preventive interventions
Health systems
strengthening
Multisectoral
approaches
CRVS
Equity, gender, and rights
Mainstreamed across areas
• Prioritizes interventions with a strong evidence base demonstrating impact
• Further focuses on improved service delivery to ensure an efficient national
response, such as through:
• Task-shifting
• Integration of service delivery
• Community health workers
• Range of factors influencing private sector service delivery
11
Scaled: Achieving financing at scale is critical to reaching 2030
RMNCAH targets
Approach begins with an understanding of the gap between resource needs
and those available for RMNCAH
The GFF works to close the funding gap by mobilizing domestic resources from
both public and private sectors. Financing is mobilized from three key sources:
• Domestic financing (public and private)
• GFF Trust Fund and IDA/IBRD resources
• Additional donor resources
40
35
Billions US$
30
25
20
Peak gap of US$25-27 billion per
year, of which ~US$11 billion is
covered by international
financing
Remaining gap of US$4-8 billion by
2030, depending on government
prioritization of RMNCAH
Resource gaps
50% of gov't health expenditure
to RMNCAH
25% of gov't health expenditure
to RMNCAH
15
10
5
2015
2030
12
Sustainable: Ensuring sustainable provision of scaled-up RMNCAH
results
Governance, social and political change
To promote
sustainability the GFF
supports countries
around all three
health financing
functions:
• Domestic resource
mobilization
• Risk pooling
• Purchasing
Health system development
Expenditure on health
Total
Government
Development
assistance for
health
Disease burden change
LIC
Economic development
LMIC
UMIC
HIC
13
Achieving and measuring results
• Results-focused financing
– Different modalities to focus on supply (e.g., performance-based
funding for facilities), demand (e.g., conditional cash transfers),
and policy (e.g., disbursement-linked indicators)
– Non-RBF modalities will also be used as appropriate (e.g., inputbased financing for capital investments)
• Measuring results
– CRVS:
• Weaknesses in CRVS have direct effects on RMNCAH
• Focus on registration of births, deaths, causes of death, and
marriage
– Other forms of measurement: DHS, MICS, routine monitoring
systems (e.g., DHIS2)
14
Agenda
• The Need and the Vision
• What: Smart, Scaled, and Sustainable Financing for Results
• How: Key Approaches to Deliver Results
• Who: The Country Platform
• The GFF Trust Fund
• Governance
• Timeline
15
How: A set of synergistic approaches drives smart, scaled, and
sustainable financing
1.
2.
3.
4.
5.
6.
Investment Cases
Complementary financing of the Investment Case
Leveraging IDA and IBRD to increase financing for RMNCAH
Health financing strategies
Crowding-in private sector engagement
Global public goods
16
1. The Investment Case
High-level vision
Consultation
Core analytics
Detailed diagnosis and prioritization
Agreement
on 2030
results
(impactlevel) and
main
obstacles to
be focused
on
Analysis by
obstacle of
demand,
supply,
enabling
environment,
multisectoral
Agreement by
obstacle on
results
(output/outco
me level) and
interventions
(long- and
short-term)
Investment
Case
17
2. Complementary financing of the Investment Case
Future: Investment Case strengthens joint
planning and complementary financing of
RMNCAH, resulting in more efficient use of
resources and better health outcomes
Donor 3
GFF Trust
Fund +
IDA/IBRD
Government
Government
Gavi or
GFATM
Donor 2
Private
sector
Investment Case
National strategic framework(s)
Current: gaps, overlaps, and funding of
activities outside national priorities
Donor
1
Donor
1
18
3. Leveraging IDA and IBRD to increase financing for RMNCAH
• GFF Trust Fund designed to encourage additional allocations
from IDA and IBRD by:
1. Committing grant resources only to countries that allocate
IDA/IBRD financing to RMNCAH
2. Adjustable volume resources allocated from the Trust Fund to
countries
3. Trust Fund resources inextricably linked to IDA/IBRD project:
Complements IDA/IBRD project rather than standalone
4. Resources can be used flexibly to provide complementary
support to implementation of IDA/IBRD financing
• Based on the historic track record under the HRITF, the
expected grant to IDA leverage is estimated to be 1:4
– Ratio will differ significantly by country
19
4. Health financing strategies
Health financing
assessment
Health financing
strategy
Implementation,
including capacity
building
Comprehensive assessment:
• Entire health sector, not only RMNCAH
• Both public and private
• Historical trends and forward-looking projections
• Efficiency and equity
Long-term vision for sustainability of financing for 2030 targets:
• Domestic resource mobilization
• Risk pooling
• Purchasing
Costed implementation plans to facilitate implementation:
• Based on national planning cycles and ideally in tandem
with Investment Case (3-5 years)
• Includes capacity building and institution strengthening
Sustainable provision of scaled-up RMNCAH results
20
5. Crowding-in private sector engagement
• There is significant untapped potential in the private sector at
the national level, including around:
–
–
–
–
Service delivery
Supply chain management
Medical technology
Access to finance
• Key entry points: Investment Cases and health financing
strategies, both of which take mixed health systems approach
• Possible complementary global approaches to mobilize
resources from the private sector:
– Health bond
– Special topic commitments
21
6. Global Public Goods
• Definition: non-excludable, non-rivalrous, benefiting multiple
countries
• Initial phase:
– Build on existing HRITF experience with evaluation and
knowledge management
– CRVS “Center of Excellence”
• Subsequent phase: specific initiatives to be defined within
these broad categories:
–
–
–
–
Knowledge, learning, and evaluation
Data and information systems
Commodities
Innovation
22
Agenda
• The Need and the Vision
• What: Smart, Scaled, and Sustainable Financing for Results
• How: Key Approaches to Deliver Results
• Who: The Country Platform
• The GFF Trust Fund
• Governance
• Timeline
23
Who: the country platform
Partners
• Government
• Civil society (notfor-profit)
• Private sector
• Affected
populations
• Multilateral and
bilateral agencies
• Technical agencies
(H4+ and others)
Structures
• Not prescriptive about
form (building on lessons
from IHP+, Global Fund,
Gavi)
• Build on existing structures
while ensuring that these
embody two key
principles: inclusiveness
and transparency
• Diversity in frontrunner
countries:
• Ethiopia and Tanzania
used existing structures
• Kenya established a new
national steering
committee
Roles
• Preparation and
endorsement of
Investment Case
and health
financing strategies
• Complementary
financing
• Coordination of
technical assistance
and
implementation
support
• Coordination of
monitoring and
evaluation
24
Agenda
• The Need and the Vision
• What: Smart, Scaled, and Sustainable Financing for Results
• How: Key Approaches to Deliver Results
• Who: The Country Platform
• The GFF Trust Fund
• Governance
• Timeline
25
GFF Trust Fund
• Eligibility
– 63 low and lower-middle income countries
– Must be willing to commit to increasing domestic resource
mobilization and to using IDA/IBRD for RMNCAH
• Roll-out
– Four frontrunner countries (DRC, Ethiopia, Kenya, Tanzania)
– Additional 10-15 countries to be selected between April and June
2015, fully apportioning existing resources
• Resource allocation
–
–
–
–
–
Three criteria: need, population, income
Methodology for combining based on IDA formula
Floor of US$10 million; ceiling of US$50 million
No repartition by issues/target population
CRVS fully integrated but additional funding of up to US$10 million if
country includes in Investment Case and uses IDA/IBRD
• Operational approach
– Fully integrated with IDA/IBRD, as in HRITF
26
Agenda
• The Need and the Vision
• What: Smart, Scaled, and Sustainable Financing for Results
• How: Key Approaches to Deliver Results
• Who: The Country Platform
• The GFF Trust Fund
• Governance
• Timeline
27
GFF governance at the global level should be designed to support two key
functions
Function 1: Ensure GFF as a financing partnership succeeds in mobilizing and co-financing
high-quality RMNCAH investment cases in GFF countries by
•
Driving partner agreement on effective strategies/policies to support aligned financing and
efficient resource allocation in/across GFF countries
•
Monitoring performance of the GFF as a partnership, and ensuring accountability for aligned
financing and for achievement of RMNCAH results in focus countries
•
Mobilizing domestic and international (including private) resources for financing of RMNCAH
investment cases at country level
•
Driving learning and innovation around effective/efficient financing approaches
•
Building high-level support for the GFF
Function 2: Ensure the GFF Trust Fund provides financing for RMNCAH investment cases that
is aligned and drives innovation, sustainability and results
•
Set strategic funding approach and priorities for financing from GFF TF, including innovative use
of TF resources to maximize mobilization of IDA and domestic resources
•
Approve GFF funding allocation
•
Agree annual work plan and budget of the TF Secretariat
•
Oversee TF and Secretariat performance to ensure investments deliver results
28
Integrated governance of GFF as a financing facility and of the GFF TF
Basic structure agreed upon; discussions ongoing on
interfaces between structures
Quality assured, nationallyowned, multi-stakeholder
process following IHP+ principles
Structurally linked governance of GFF
financing facility and of GFF TF
•
Investment Case
aligned co-investments
•
+IDA
GFF Trust
Fund
•
GFF
Secretariat
World Bank
Board
Trust Fund
Committee
•
•
GFF Investors Group
PMNCH
•
UNSG High Level
Champions Group
GFF Investors Group leads governance
of multi-stakeholder financing
partnership to ensure effective cofinancing of RMNCAH investment
cases in GFF countries (Function 1)
GFF TF Committee: subset of the
Council (TF donors) with devolved
decision-making on GFF TF allocations
(Function 2)
GFF Secretariat manages TF and
provides support to Council and TF
committee
WB Board: final commitment of TF
and IDA resources; fiduciary oversight
PMNCH leads global advocacy and
accountability on Global
Strategy/EWEC; conducts broader
stakeholder engagement around GFF
UNSG Champions Group would
include GFF as a key financing
platform for Global Strategy
29
Composition and working mode of GFF Investors Group
Membership in the Investors Group is based on active contribution to the success of the
GFF and promotes the engagement of stakeholders who make substantial financial or inkind assistance to Investment Cases and health financing strategies:
Participating countries (ministries of health & finance)
4 – 6 members
Bilateral donors contributing to the GFF
4 – 6 members
H4+ partners
3 members
World Bank
1 member
Gavi and Global Fund to Fight AIDS, Tuberculosis and Malaria
2 members
Non-governmental organizations (one each from developing and
developed countries)
2 members
Private sector (including private foundations)
2 members
PMNCH
1 member
There will be some flexibility to include new donors to the Investors Group; however, to remain nimble, a sharing of seat or rotation
system may be introduced.
30
Agenda
• The Need and the Vision
• What: Smart, Scaled, and Sustainable Financing for Results
• How: Key Approaches to Deliver Results
• Who: The Country Platform
• The GFF Trust Fund
• Governance
• Timeline
31
GFF timeline
GFF Launch
UNGA
GFF
Announcement
Spring Meetings
Washington, DC
FfD
Addis Ababa,
Ethiopia
BUSINESS PLANNING
SEP
2014
OCT
2014
DEC
2014
OPERATIONAL PLANNING & SETUP
FEB
2015
COUNTRY & STAKEHOLDER CONSULTATIONS
NGO Consultations
APR
2015
MAY
2015
JUL
2015
SEP
2015
FINANCING COMMITMENTS
World Health
Assembly
Geneva
Business Plan
• Process supported by multi-stakeholder Oversight Group & Business Planning Team
• 4 frontrunner countries
32