Global Financing Facility in support of Every Woman Every Child

CSO Consultation, November 14 2015

• Reduction in <5 mortality rate: from 90 deaths per 1,000 live births in 1990 to 46 in 2013

• Reduction in MMR: from 380 deaths per 100,000 live births in 1990 to 210 deaths in 2013

Significant progress but much remains to be done

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1990 1995 2000 2005 2010 2015

Under-five mortality rate (per 1,000 live births)

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1990 1995 2000 2005 2010 2015

Maternal mortality ratio (deaths per 100,000 live births)

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Every Woman Every Child Global Strategy

• Action areas – Country leadership – Financing for health – Health systems

resilience – Individual potential – Community

engagement – Multisector action – Humanitarian and

fragile settings – Research and

innovation – Accountability

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GFF is a financing partnership in support of EWEC and country leadership

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The big picture: ODA is declining as a share of financing flows to developing countries

…and financing to health from domestic sources – both public and private – increasingly dwarves international contributions

• Private expenditure on health is >50% of total health expenditure in more than 60% of GFF countries

Sources: OECD, NHAs

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GFF timeline

UNGA New York

NGO Consultations

Business Plan completed

Spring Meetings Washington, DC World Health

Assembly Geneva

FfD Addis Ababa, Ethiopia

SEP 2014

OCT 2014

DEC 2014

FEB 2015

APR 2015

MAY 2015

JUL 2015

SEP 2015

GFF launch, including 2nd wave countries

BUSINESS PLANNING OPERATIONAL PLANNING & SETUP

FINANCING COMMITMENTS COUNTRY & STAKEHOLDER CONSULTATIONS

GFF announcement

EWEC launch; 1st Investors

Group

OPERATIONS

Process supported by multi-stakeholder Oversight Group & Business Planning Team

Countries leading the way

• Frontrunners: DRC, Ethiopia, Kenya and Tanzania • Second wave: Bangladesh, Cameroon, India, Liberia,

Mozambique, Nigeria, Senegal, and Uganda

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Bridging the funding gap for women’s, adolescents’, and children’s health

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The combined effects would prevent 24-38 million deaths of women, adolescents, and children by 2030

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Overview of the GFF

Smart

Scaled

Sustainable

Results

1. Investment Cases for RMNCAH

2. Mobilization of financing for Investment Cases

3. Health financing strategies

4. Global public goods

The “what” of the GFF The “how” of the GFF The “who” of the GFF

The GFF as a broader facility

The GFF Trust Fund

Governance

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1. 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 rights Mainstreamed 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 Case road-map

• Roles • Timeline • Milestones • Potential TA

needs • Agreement

on country platform

Situation analysis • 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

1. 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

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2. Quality Investment Cases with aligned financing drive results

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Nat

iona

l str

ateg

ic fr

amew

ork(

s)

Investment Case

Government

Donor 1

GFF Trust Fund +

IDA/IBRD

Gavi, Global Fund, other multilateral

Donor 2 Donor

1

Donor 3

Private sector

Government

The Investment Case sharpens the focus on evidence-based, high impact interventions while reducing gaps and overlaps as financiers increase funding for RMNCAH

2. Repartition of financing

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Inve

stm

ent C

ase

Government

Donor 1

GFF Trust Fund +

IDA/IBRD

Gavi, Global Fund, other multilateral

Repartition of financing will not occur automatically: requires dialogue between ministries of health and of finance, and among external financiers

1. Institutionalization of priorities (e.g., in budgets and MTEFs) requires sustained dialogue between ministries of health and of finance

2. Many key donors have expressed willingness to support Investment Cases, but achieving this requires sustained dialogue at the country level

3. Health financing strategies

• Objective: help countries develop and implement strategies to build sustainable health financing systems and thus attain their health financing goals

• Scope: Health sector-wide • Timeframe: through 2030 • Key issues being addressed:

– Defining right to health as an entitlement

– Increasing domestic resources for health

– Improving efficiency – Improving coordination of

development assistance – Reducing inequities

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Strategy development

Strategy implementation

including capacity building

Health financing system assessment

GFF Trust Fund

• Grant resources linked to IDA/IBRD financing – US$875 million pledged to date from Canada, Norway, and the Gates

Foundation

• Country selection: – Eligibility: 62 low and lower-middle income countries

• Must be willing to commit to increasing domestic resource mobilization and interested in using IDA/IBRD for RMNCAH

– Initial set of 12 countries mentioned earlier

• Resource allocation: – Range of US$10 to 60 million per country (grant funding only, not

including IDA/IBRD) • Based on need, population, and income

– Expected ratio of 1:4 for trust fund:IDA (on average, not in every country)

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GFF governance at the country level: the country platform

• Preparation and finalization of Investment Case and health financing strategies

• Complementary financing

• Coordination of technical assistance and implementation support

• Coordination of monitoring and evaluation

• Not prescriptive about form

• 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

• Government • Civil society (not-

for-profit) • Private sector • Affected

populations • Multilateral and

bilateral agencies • Technical agencies

(H4+ and others)

Approach Partners Roles

GFF governance at the global level

• GFF Investors Group: – Members: 23 representatives of developing and developed

countries, multilateral organizations, foundations, civil society, private sector

– Role: governance for the facility, including ensuring effective co-financing of Investment Cases; not decision-making on individual Investment Cases

• Trust Fund Committee:

– Members: key donors to trust fund – Role: governance of the trust fund resources, including

decision-making on selection of countries and allocations to countries

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Sources of Financing - IBRD, IDA, Trust Funds

•To countries with a per capita income (GNI) of US$1,215 or more (FY16). • IBRD can finance IPF, PforR, DPF •Borrowers have a range of options with respect to repayment terms and currencies

IBRD

•Cut off per capita income less than US$1,215. An exceptions on a temporary basis for selected countries, such as: • Countries undertaking major adjustment efforts but are not creditworthy for IBRD financing • Small island economies that lack creditworthiness

•The repayment period for IDA credits varies from 25 to 40 years depending, with a 5 to 10 year grace period

•Low income debt-distressed countries may qualify to receive all or part of their IDA financing on grant terms

IDA

•Bank operations can be financed through Recipient-executed trust funds (RETFs) that are administered by the Bank but executed by a third party (a recipient/client).

•RETFs generally are provided to the recipient on a grant basis. The Bank charges a fee to recover its costs.

Trust Funds

IDA : All you need to know in two (crowded!) slides • Currently supports 77 countries (plus India) – 39 of these

countries are in Africa [2.8 billion of the world’s poor] • Single largest source of funding for basic social services in

these countries • About 65% of IDA funds come from donor contributions

(other: IBRD, IFC, previous IDA repayments) • Since donor funds are pooled, IDA can leverage a large capital

base that is un-earmarked • IDA 17 is from FY14-FY 17 and attracted a record $52 billion • IDA is there for the long haul – long term development • Global leader in transparency

– Undergoes the toughest independent evaluations of any international organization

– “smart’ funding (UK, Australia, CGD)

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IDA : All you need to know in two (crowded!) slides • IDA allocation to a country is based on

– Country’s relative poverty • GNI per capita • lack of creditworthiness to borrow in the markets)

– Policy and institutional assessment • Promote economic growth • Reduce poverty

– Country performance • Portfolio performance

– Other • Per capita income • Population size • For IDA 17, 50% of funding should go to Sub-Saharan Africa, warranted on

performance

• Allocation of IDA within a country’s envelope is through the CPF

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Relationship between IDA and GFF Trust Fund

No separate application process for GFF Trust Fund – Fully integrated within Bank operations – uses the same

operational and administrative processes (low management costs)

– Linked to IDA/IBRD operations that support RMNCAH – Uses Bank expertise across entire World Bank Group including

IFC – Uses same operational and administrative processes – Builds on the experience and management capacity of the

existing Health Results Innovation Trust Fund

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