Global Financing Facility

Incentivize the Prioritization of Adolescent Sexual and Reproductive Health and Rights (ASRHR) and girls’ empowerment through RBF mechanisms (global and specific countries)

Duration: 60 days, September 2020 - June 2021

Background

Accelerating economic growth in countries at the bottom of the Human Capital Index (HCI) requires unlocking the potential of women and girls. Human capital—the aggregated skills and knowledge of a population—is the most significant store of global wealth, reflecting the ability of populations to adapt, innovate, and perform competitively in markets. There is a vast opportunity to improve human capital investments in adolescents aged 10-19 years, as 90 percent of the 1.2 billion adolescents worldwide live in developing countries. Additionally, this younger population presents a window of opportunity for accelerated economic growth or experiencing a demographic dividend.

Improving adolescent wellbeing, including sexual and reproductive health and rights, is a priority area of investment to create the conditions for demographic transition and human capital accumulation for women and girls. Adolescent fertility both contributes to total fertility and limits the ability of young women to accumulate human capital. In 2018, 21 million adolescent girls aged 15 to 19 in developing regions were expected to become pregnant. Because approximately 40 percent of all pregnancies from developing countries are unplanned, attention to adolescent sexual and reproductive health and rights (ASRHR) is essential. Additionally, this challenge has important equity dimensions: populations with highest fertility rates are largely those from the bottom income quintiles and from the subnational pockets where the population least able to invest in their human capital. In Cote d’Ivoire the number of years of schooling for girls is 4.1 year versus 6.1 year for boys. These health outcomes therefore have a high impact on adolescents’ retention and completion rate in schools and their learning outcomes, in particular for girls.

The Global Financing Facility

The Global Financing Facility (GFF) - which is hosted by the World Bank - was launched in 2015 to help address gaps in financing for the systems and interventions needed to improve reproductive, maternal, newborn, child, adolescent health and nutritional outcomes. At the global level, the GFF has identified adolescent fertility as one of the priorities across the lifecycle from pregnancy, birth, early years to adolescence, and includes reducing age-specific fertility rate for adolescents (15-19 years) as one of the eight core outcome goals. Adolescent health and nutrition are also relevant and influences the achievement of the other key outcome goals. Since the launch in 2015, the GFF has worked with 36 countries to identify their prioritized RMNCAH-N Investment Cases to improve the health and nutrition of women, children, and adolescents. Across current GFF countries with completed investments cases, 80 percent have identified and prioritized adolescent health results.

Under the umbrella of the GFF ASA on Strengthening Evidence to Improve Adolescent Sexual and Reproductive Health in Support of Human Capital a new work stream will be developed on access to family planning and sexual and reproductive health services for adolescent girls. Indeed, access to ASRHR is limited to greater and lesser degrees in all countries around the world. Some barriers are prescribed by law; others derive from inequitable access to services as well as social, religious, moral or other beliefs and norms. Performance-based financing (PBF) may serve as an effective incentivizing mechanism to encourage policy-makers, service providers, and other platforms to reach adolescents by providing adolescent friendly SRH-services, conducting outreach geared toward the needs of adolescents, invest in local demand generation focused on this beneficiary population, or engage with local youth-led organizations to improve the experience of care for adolescent health service users. Performance-based financing (PBF) rewards the delivery of quality services through financial incentives, upon verification that the agreed-upon result has been achieved, in a manner that can be credibly sustained over time. PBF has expanded rapidly in Africa, with several countries implementing nationwide PBF programs and nearly twenty more with ongoing pilots. While PBF is a promising approach to guide adolescent health service delivery, there are few examples of largescale programs tailored to guide quality sexual and reproductive health services specifically to this demographic to impact their health and education outcomes and increase their human capital. The aim of this consultancy is therefore to produce both a global good, and specific technical support to countries. Country-specific work will be for 5-7 countries, mainly situated in West and Central Africa.

Duties and Deliverables

The objective of the consultancy is to assess the potential for PBF mechanisms to improve adolescent SRHR and service delivery and impact adolescent girls empowerment by meeting their specific needs where and when they need it and thereby allow them to stay in school during pregnancy and return after pregnancy, and suggest potential solutions to address this.

The GFF therefore seeks to engage an international development expert or a firm with strong knowledge of adolescent health and sexual and reproductive health and rights interventions and multi-sectoral interventions through platforms that target adolescents (as school platforms) to conduct research on the most effective PBF mechanisms to encourage health service providers to deliver quality services that are adolescent friendly. As part of this research, the consultant will consider how the PBF mechanism can facilitate referral pathways and supportive wraparound services between secondary schools and local health facilities.

Specifically, the Consultant (or Firm) is asked to:

Analytical work that will serve as a global good

1. Conduct a literature review on the use of performance-based financing to improve programs targeting the needs of adolescents, with a specific focus on adolescent girls, and develop a summary brief on key findings and recommendations;
2. Review World Bank health and education portfolio to document operational practices for using performance-based financing (at community, facility, and sub-national, and national levels) to meet the needs of adolescent beneficiary populations;
3. Develop standardized tools, such as Terms of Reference, to support World Bank Task Teams to procure targeted support to advance adolescent health, in particular ASRHR, within projects that utilize RBF approaches;
4. Produce a standard quality checklist for youth friendly health services that can be integrated into quality verification tools used in PBF platforms and develop a menu of quantity-based indicators that respond to priority adolescent health interventions.

Country-Specific technical support

1. Support the World Bank Team in collaboration with the GFF team to review and adapt the materials for a scale-up of the PBF investment to better target adolescent SRH services, including: (i) a situational analysis through review of country documents, current PBF-manual and available disaggregated data; (ii) identification of platforms and opportunities to incentivize for ASRHR and impact on health and education outcomes, and (v) standardized protocols and guidelines for increased impact on ASRHR through PBF;
2. Support the World Bank Team, PIU and GFF team to engage in discussions with the client country on the importance of addressing this issue through the RBF-mechanism;
3. Support the country team to produce an operational brief that identifies what and how to incentivize and through which platforms; what and how to measure, report, and evaluate achievement of incentivized actions and outlines suggestions to adapt the country PBF-mechanism in this sense; and
4. Produce a knowledge and learning product on the country experience on integrating ASRHR in PBF for sharing with the country team, PIU, and GFF’s Community of Practices; allow for two rounds of feedback following internal review.