The GFF’s business plan describes our roadmap for achieving dramatic increases in financing for reproductive, maternal, newborn, child, and adolescent health (RMNCAH) in high-burden, low-income and lower-middle-income countries by 2030.
The GFF: Pioneering a new financing model
The GFF is pioneering a financing model that shifts away from a sole focus on official development assistance. Instead, the GFF approach combines domestic financing, external support, and innovative sources for resource mobilization and delivery, including the private sector.
The GFF harnesses the power of its diverse set of partners. Under the leadership of national governments, GFF partners use a country platform that builds on existing structures while ensuring inclusiveness and transparency.
Key means to delivering results
The GFF operates at the country level through a multiple-stakeholder process that builds on International Health Partnership (IHP+) approaches. National governments lead the processes with the involvement of the full set of RMNCAH stakeholders, each of whom brings a distinct comparative advantage to the process. Most countries are using existing coordinating structures as their country platforms, though some have decided to establish new mechanisms to improve coordination.
Within these constituencies, it is important that the right skills and institutions are represented in the process. For example, the ministry of finance is a critical stakeholder in the process and so should be involved in every country.
The Investment Case is a description of the improvements that a country wants to see with regard to RMNCAH and a prioritized set of investments required to achieve these results. It is not a comprehensive description of all of the RMNCAH activities under way in the country. Instead, it presents a compelling case for how a limited number of priorities will put the country on the path to improve the health of women, children, and adolescents over the long term and therefore contribute to the achievement of the Sustainable Development Goals. The Investment Case guides—and attracts—financing from GFF partners, including national governments, over a three- to five-year period.
The Investment Case is focused on efficiency through “best buys” in RMNCAH: the evidence‐based, high‐impact interventions that equitably reduce morbidity and mortality while progressively realizing the rights of women, children, and adolescents. It also considers broader health-system issues, such as governance and supply chain management, and the extent to which investments in non-health sectors might positively impact RMNCAH results.
A country-specific approach is essential to the development of the Investment Case, given the significant differences between countries in the existence and quality of data and evidence-based programming and current plans.
Mobilization of financing for the Investment Case
The GFF mobilizes resources for the Investment Case by improving the efficiency of current financing and attracting additional resources from multiple sources.
1. Complementary financing of the Investment Case
Once the priorities of an Investment Case are agreed upon, financiers, both national and international, decide jointly which elements will be financed by each partner, through a country-led process. This reduces gaps and overlaps in financing and ensures that financing is directed toward priority, high-impact interventions.
Each financier complies with its own funding procedures. Several different modalities may be used to deliver financing in a single country, including pooling with the government, single- or multiple-donor trust funds, and parallel financing.
The financiers for an Investment Case participate in country-led implementation review and support, a process that varies from country to country due to particular situations and contexts.
2. Increased government investment in RMNCAH
It will take significant increases in domestic financing to close the RMNCAH resource gap. The GFF facilitates the development of health financing strategies that contain concrete plans for domestic resource mobilization. The approaches supported by the GFF are both formal and informal.
3. Linking grant funding to IDA and IBRD projects
The GFF Trust Fund, a multiple-donor trust fund hosted by the World Bank, provides grant funding to countries alongside International Development Association (IDA) and International Bank of Reconstruction and Development (IBRD) financing. Existing World Bank Group procedures determine the allocation of IDA/IBRD financing to countries, and each government determines how its IDA/IBRD resources are allocated among different national priorities in its development agenda.
Linking GFF Trust Fund financing to IDA and IBRD projects offers several benefits:
- It helps to lower transaction costs and increase efficiency;
- It situates the Trust Fund resources in the strategic dialogue between governments (including ministries of finance) and the World Bank;
- It assists in assuring that Trust Fund resources are on-budget and provided in addition to the IDA and IBRD financing; and
- It encourages the use of Trust Fund resources to simultaneously support the design of Investment Cases.
4. Innovative engagement of global and local private sector resources
The GFF seeks to use the flexibility of its Trust Fund and the expertise of its facility partners to draw in the financial resources and capacity of the private sector to help countries achieve RMNCAH target outcomes. In line with the general GFF principles, the GFF’s private sector engagement will be equity-driven and prioritize the most disadvantaged women, children, and adolescents. Private sector engagement around the GFF will be values-driven, with an emphasis on social impact rather than purely commercial returns.
Pathways for engagement with private sector
The GFF has three main pathways for private sector engagement in the short run:
- Developing innovative financing mechanisms to catalyze private sector capital for Investment Case financing;
- Facilitating partnerships between global private sectors and countries; and
- Leveraging private sector capabilities in countries to deliver on Investment Case objectives.
Health financing strategy
The health financing strategy assists countries to analyze, plan for, and implement efforts to promote financial sustainability to accelerate progress on RMNCAH and universal health coverage. It systematically addresses broader health financing challenges, such as domestic resource mobilization.
The development of a health financing strategy typically begins with an assessment that examines all aspects of health financing in the country: the sources of financing, the design of the financing system, the policies and practices governing various health financing functions, the processes and capacities, and political economy considerations.
Based on this assessment, the GFF supports countries to develop a health financing strategy that articulates a long-term vision for the sustainability of financing. It is complemented by a costed implementation plan that sets out shorter-term steps for achieving the strategy’s milestones and investments.
Investments in public goods that support results
The GFF supports the development of global public goods, which can play an important role in improving RMNCAH outcomes and facilitating a more efficient use of funds at the country level. The GFF engagement on global public goods will progress in phases. Initially, it will focus on:
- Building and expanding the capacity and experience of the Health Results Innovation Trust Fund in knowledge, learning, and evaluation while supporting other important actors in this area; and
- Supporting the development of a “Center of Excellence” on civil registration and vital statistics (CRVS), with the intent of strengthening national CRVS systems.
GFF Trust Fund
The GFF Trust Fund (Trust Fund) is a central component of the GFF. This multiple-donor trust fund has been established at the World Bank to provide additional financing for RMNCAH by linking grant funding to IDA or IBRD projects. The Trust Fund mobilizes the expertise of the entire World Bank Group, including the International Finance Corporation (IFC), the World Bank Group’s private sector arm. It builds on the experience of the Health Results Innovation Trust Fund in providing results-focused financing to support countries to achieve RMNCAH results.
As of April 2016, the Trust Fund had received US$815 million in commitments from the governments of Norway and Canada and from the Bill and Melinda Gates Foundation.
Criteria used for initial Trust Fund allocations
A total of 66 high-burden, low-income and lower-middle income countries are eligible to receive grant resources from the Trust Fund. The Trust Fund began its operations with an initial set of four “frontrunner” countries: the Democratic Republic of the Congo, Ethiopia, Kenya, and Tanzania. An additional eight countries followed: Bangladesh, Cameroon, India, Liberia, Mozambique, Nigeria, Senegal, and Uganda.
These countries were chosen through a multistep process. A set of criteria (e.g., RMNCAH outcomes, domestic resource mobilization, and IDA/IBRD financing for health) were used to generate a “long list” of countries that was then compared to the lists of priority countries that individual GFF partners had identified for their work (i.e., based on their own plans for engagement). After a final list was compiled, consultations were held to gauge the interest of countries in participating in the GFF process, and the final selection was made by the financiers to the GFF Trust Fund.
Future Trust Fund allocations
The GFF is prioritizing the initial 12 countries to learn and share from their experiences and to maximize the opportunity for success. It is important to note that the first 12 countries represent 47 percent of the RMNCAH financing gap of the high-burden, low-income and lower-middle income countries, and 61 percent of the maternal and child deaths in these countries.
Additional financial contributions to the Trust Fund will be needed for new allocations to be made. In the meantime, the GFF will ensure that the global public goods that are available as part of the GFF will be made available to all GFF-eligible countries. Two key elements of this are the documentation and dissemination of lessons learned from the initial 12 countries and the preparation of guidance materials that can be used by all 63 countries.