As a busy working mom, long international flights are when I find time to reflect. And I had plenty to reflect on during my flight this week to Cote d’Ivoire for the twice-yearly meeting of the Investors Group of the Global Financing Facility for Women, Children and Adolescents (GFF). My reading material on the plane was the new GFF annual report – and I am so proud to see how far the GFF has come in four short years.
This year, the GFF was able to expand its support to 36 countries from just 4 when the GFF was established in 2015. This tremendous growth happened because countries are voting with their own pocketbooks and adopting the GFF’s country-led approach, which aligns resources from international partners and links them to domestic health plans and budgets to drive better results.
And this growth was made possible by the GFF’s incredible international partners – a list that is also getting longer. Over the past year we received more than US$1 billion in pledges of additional financing for the GFF Multi-Donor Trust Fund, with generous support from the GFF’s donors. Reaching these two milestones, GFF is well on its way toward its goal of supporting 50 countries with the highest maternal and child mortality burdens and financing needs.
This support is more urgent than ever: the latest estimates show that 2.8 million pregnant women and newborns die every year – one every 11 seconds – mostly of preventable causes. Yet in most low and lower-middle income countries today, health financing is too low, too inefficient and too inequitable to address these challenges. The World Bank estimates that 54 low- and lower-middle-income countries will need an additional $176 billion by 2030 to finance an essential package of quality services for all. These challenges are why the GFF exists.
For me, the most exciting part of the annual report is the collection of 27 country profiles and seven in-depth country cases, which show how GFF-supported countries are leading the way in transforming their approaches to health financing and improving health outcomes for their populations. Per capita health expenditure financed by domestic sources has increased in 19 of the 27 countries profiled, neonatal and under-five mortality has decreased in all 27 countries, and the adolescent fertility rate has decreased in 26 of the 27 countries.
With support from the GFF, more money is translating into more resources to expand delivery of lifesaving health care for women, children and adolescents in underserved communities. For example, in Kenya, we found that all 47 counties met the criteria of increased allocations to health in their budgets over the past two years, with some allocating more than 30 percent of their budget to health (well above the 20 percent requirement). Nineteen of the 47 counties increased their budget allocations for health by at least 5-10 percent or more.
I was able to see the progress first hand visiting Tanzania a few weeks ago, where antenatal care improved from an average of 35.8 percent in 2014 to 64.1 percent in 2018, with almost one-third of Tanzania’s regions reaching 70 percent or more of women. Alongside improvements in antenatal care were increases in the regional average for the share of births at a health facility, which rose from 67.0 in 2014 to 79.6 percent in 2018. That’s real progress.
The report shows that every country supported by the GFF has its unique set of challenges and its own path to progress. But across the board, it’s also clear that the GFF approach is on the right track in creating opportunities for some of the most vulnerable women, children and adolescents in the world.
By catalyzing more and better domestic resource mobilization, the GFF approach is enabling governments to make more cost-effective and efficient investment decisions in health and nutrition. Collaboration with international partners, including the Global Fund for AIDS, Tuberculosis and Malaria and Gavi, the Vaccine Alliance among others, is key to multiply impact in countries.
Here in Côte d’Ivoire, for example, the country’s investment case argues for at least a 15 percent annual increase in the health budget—a commitment made at the GFF replenishment event in Oslo in November 2018 and reinforced by the country’s vice-president at Côte d’Ivoire’s first National Dialogue on Health Financing, in May 2019. With support from the GFF, earlier this year the prime minister and the minister of health established the National Platform for Health Financing, a multisectoral platform which aims to ensure effective implementation of these commitments and better align external resources with the government’s agenda and budget.
The GFF is also multiplying available resources for women’s, children’s and adolescent health to help take countries take their health system strengthening efforts to national scale. So far we’ve helped mobilize more than USD$2 billion in private capital by deploying a range of innovative financing tools, such as a Sustainable Development Bond series that focuses on the health and nutrition of women and children linked to co-financing and loan buy-down grants for GFF countries. In 2019, the GFF worked with Grand Challenges Canada, the World Bank and other partners to launch a groundbreaking Development Impact Bond focused on newborn health in Cameroon, which seeks to save the lives of at least 2,200 newborns each year by expanding the use of Kangaroo Mother Care. And we’re just getting started: As these types of mechanisms demonstrate results, I am confident we will continue to crowd-in more investors.
So, please take a few minutes to look at our annual report and read the progress for yourself. Although the GFF partnership is still very young, the report makes it clear that many countries are moving towards their goal to give all women, children and adolescents the opportunity to live healthy, productive lives. I can’t wait to see how much more we are going to do by the time we turn 5!