Global Financing Facility in supportof Every Woman Every Child

Investing for RMNCAH results

2

The big picture: what are we trying to accomplish?

• Smart financing: improving efficiency by approximately 15% in 2030• Scaled financing: crowding-in domestic resources and attracting new

external support – mobilizing a cumulative total of >US$57 billion between 2015 and 2030)

3

What do we need to focus on?

• Implementation challenges: Implementation barriers and evidence-based strategies to overcome them for achieving results especially for groups such as adolescents, urban slum dwellers, or rural women

• Maximizing the returns on investment: Agreeing and aligning on a set of priorities that can be implemented given the resources available (while mobilizing additional resources)

• Smarter, scaled, and sustained financing: Addressing the fact that financing for RMNCAH has been characterized by gaps, overlaps, and funding for areas outside of national priorities

Acceleration of results

4

Why do we need an Investment Case: theory of changeN

ation

al st

rate

gic

fram

ewor

k(s)

Investment Case

Government

Donor 1

Donor 2

GFF Trust Fund +

IDA/IBRD

Gavi, Global Fund, other multilateral

Priv

ate

sect

or

Donor 2Donor

1

Donor 3

Private sector

Government

The Investment Case aims to drive agreement among key stakeholders on a set of priorities that can feasibly be implemented given the resources available, and then to shape the financing of such priorities

5

Scope of Investment Cases

Clinical service delivery and preventive interventions

Health systems strengthening

Multisectoral approaches

End preventable maternal and child deaths and improve the health and quality of life of women, children, and adolescents

Serv

ice

deliv

ery

appr

oach

es

CRVS

Equity, gender, and rightsMainstreamed across areas

• Prioritizes interventions with a strong evidence base demonstrating impact• Emphasizes issues (e.g., family planning, nutrition) and target populations (e.g.,

adolescents) that have been historically underinvested in• Further focuses on improved service delivery to ensure an efficient national

response (e.g., through task-shifting, integration of service delivery, community health workers, private sector service delivery environment)

Investment Caseroad-map

• Roles• Timeline• Milestones• Potential TA

needs• Agreement

on country platform

Core analytics

• Equity• Sub-national

differences• Efficiency• Multisectoral

determinants• Upcoming

structural shifts

Costed options and resource map

• Costed set of interventions and strategies (including multisectoral components)• RMNCAH

resource landscape by program, location and partner

Prioritized Investment Case

• Set of priority interventions/strategies that fit within available resources• If appropriate,

scenario analysis with different sets of interventions and strategies based on different scenarios of resource availability• Results framework

with plans for monitoring and evaluation

Commitments and alignment to Investment Case

• High level agreement on co-financing between government and partners, and within government between ministries of health and finance

Costing, cost-effectiveness, and resource

mapping

Approach to Investment

Case development

Impl

emen

t

Core set of interventions and strategies

• Agreement on 2030 targets and 5 year milestones• Identification of

priority high-impact interventions• Core strategies

to address system bottlenecks • Multi-sector

interventions including CRVS

Overview of process and outputs towards a quality Investment Case

Results and key interventions and strategies

Agreement on repartition of financing for

the Investment Case

Core analytics

Prioritization and maximization of

returns on investment

6

7

Key issues: core analytics

• Significant improvements in recent years – many countries more analytical in assessments of changes in epidemiology and in coverage

• GFF brings sharper focus on:– Equity– Sub-national differences– Efficiency– Multisectoral determinants– Upcoming structural shifts (e.g., economic growth,

urbanization, demographic changes, climate change)

8

Key issues: results and key interventions and strategies

• GFF approach:– Definition results that a country wants to achieve over the

longer term– Mix of interventions and service delivery modalities that are

appropriate for the epidemiological context– Focus on core systemic bottlenecks and inefficiencies, including

identifying long-term transformational initiatives– If appropriate given core analytics, multisectoral investments

(including CRVS)

9

Key issues: costing, cost-effectiveness, and resource mapping

• Improvements in costing in recent years, but cost-effectiveness not systematically assessed and resource mapping efforts uneven

• GFF approach:– Costing based on existing approaches in use– Effectiveness should be quantified to the extent possible– Resource mapping should include fiscal space analysis (but idea

is not an exhaustive exercise -> practical, rough estimates for to guide decision-making)

10

Key issues: prioritization

• Limited progress in many countries• GFF approach:

– Investment Case should contain prioritized set of interventions and strategies that can be implemented within resource envelope

– Scenario planning may be useful, given uncertainties about resource availability and desire to include “full need” scenario

• GFF brings sharper focus on:– Optimizing inputs: focus on efficiency gains– Maximizing outcomes: cost-effectiveness analysis– Addressing the specific health needs of vulnerable groups:

identification and targeting

11

Key issues: agreement on repartition of financingIn

vest

men

t Cas

e

Government

Donor 1

Donor 2

GFF Trust Fund +

IDA/IBRD

Gavi, Global Fund, other multilateral

Priv

ate

sect

or

Repartition of financing will not occur automaticallyTwo key processes: dialogue between MoH and MoF, and among external financiers

1. Key issue is institutionalization of priorities, particularly through budgets and MTEFs; requires sustained dialogue between MoH and MoF, facilitated by analytical work that will speak to MoF concerns; GFF can support that through a range of mechanisms (next slide)

2. A number of key donors (e.g., USAID, JICA, DFID, Canada, Norway, Gavi, Global Fund) have expressed willingness to support Investment Cases, but achieving this requires sustained dialogue at the country level (ideally both through government-donor dialogue and among donors)

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What lessons learnt and need to be learnt?

• Country platform• Inclusion of previously neglected program areas and

population groups• Prioritization• Technical assistance• Quality assurance• Relationship with implementation