Country Case Study GFF Work in Liberia. Shun Mabuchi Country Health Team Leader The World Bank With contribution from MoH team June 20, 2017

Transcription

1 Country Case Study GFF Work in Liberia Shun Mabuchi Country Health Team Leader The World Bank With contribution from MoH team June 20, 2017

2 Outline Liberia Context How the GFF works in Liberia (so far) Reflections 1 Presentation Title

3 Liberia context Ebola devastated the country, and can come back again Ebola devastated the country Ebola can reemerge anytime Country is still fragile to outbreaks Loss of GDP by 3.4 pps ($66M) in 2014, and pps ($ M) in 2015 (World Bank, 2014) Poverty prevalence increased from 5.5% to 17.6% in (UNDP, 2015) We do not know whether West Africa remains vulnerable to another large outbreak in 2016 or anytime in the future (WHO Ebola Response Team, 2016) Key weaknesses continue to exist in community level surveillance; national laboratory network, laboratory quality, HR workforce, a multi-hazard public health emergency preparedness and response plan (JEE report, 2016). 2

4 Liberia context Health system is still weak and fragile, leading to challenging health outcomes Access to HFs: 29% of population outside of the 5km radius. Gbarpolu at 69% Human Resources: physicians per 1,000 population (lowest in the world) Quality: 4% of HFs had functional Blood banks; 74% of health workers lack skills in manual uterine compression Commodities: 71% of HFs Stocked out of Tracer Family Planning products & Oxytocin Health Financing: OOP is 51% of NHE; 60% dependent on donors Information Systems: <30% births and death events registered Maternal mortality ration 725 per 100,000 live births (7 th largest in the world) Under-five mortality rate 71 per 1,000 live births 32% of among children under five suffer from stunting 3

5 Liberia context Post-Ebola reconstruction process suffers from fragmentation Too many priorities o National investment plan has 9 pillars, 59 priority investments, requiring US$243 million (~US$61 per capita) every year for seven years Fragmented implementation and poor accountability o 80% of health spending from external sources o 94 non-gol organizations working in Health in Liberia 3

6 Outline Liberia Context How the GFF works in Liberia (so far) Reflections 5 Presentation Title

7 Recap - How the GFF works A country driven process 1. Prioritizing Country ownership and leadership 3. Learning Identifying priority investments to achieve RMNCAH outcomes Identifying priority health financing reforms Strengthening systems to track progress, learn, and coursecorrect 2. Coordinated Coordinated implementation Reforming financing systems: -Complementary financing -Efficiency -Domestic resources -Private sector resources financing and implementing Support countries to get on a trajectory to achieve the SDGs: Accelerate progress now on the health and wellbeing of women, children, and adolescents Drive longer-term, transformational changes to health systems, particularly on financing

8 Prioritizing RMNCAH IC was developed by multi-agency agency team under the leadership of the government 4 Role of the IC Team Process/ Timeline A subset of the National Investment Plan for building a resilient health system (2015) An update of Accelerated Action Plan to Reduce Maternal and Neonatal Mortality (2012), reflecting more analyses and lessons from the EVD crisis A Core team of MOH, MOF, UNs (WHO,UNFPA, UNICEF), WB, bilateral (USAID), NGOs (e.g., CHAI, LMH), with TA support from the GFF Secretariat Consultations with county multi-sector team, civil society groups October 2015 November 2016 (over 1 year) Bottleneck analysis; prioritization of focus areas and counties; development of packages for each focus area by groups; experts inputs; costing; and resource mapping 6

9 Prioritizing Investment case went through data-driven bold prioritization Coverage of interventions across the continuum of care Focus areas from analyses: Quality EmoNC (incl. postnatal) MNDSR Adolescent health CRVS Sustainable community engagement Governance and leadership 8

10 Prioritizing Investment case went through data-driven bold prioritization County prioritization based on the analysis of ~20 service indicators 9

11 Prioritizing Health financing strategy was integrated into health system reforms Areas Short term ( ) Medium term Long term Resource mobilization Governance Pooling Strategic Purchasing Service Delivery Demand-side interventions DRM: increase tax revenue, taxes earmarked for health - Build Joint Program Coordination Unit - Establish functions for LHEF - Strengthen capacity of HFU - Strengthen procurement - Further align donor resources with Investment Plan and RMNCAH IC - Establish purchasing agency - Increase number of donors on the Donor Pool Fund - Regular resource mapping and alignment (throughout) - WB and USAID PBF as a model to provide autonomy to health facilities - Align stakeholders on resource allocation formula for counties - Update costing of EPHS - Roll out CHA program - Reform supply chain governance - Establish quality standard, etc. - Monitor OOP and catastrophic expenditure - DRF pilot to test to user fees - Pool private resources (premium) - Scale up consolidated PBF throughout the country - Implement capitation grant based on resource allocation formula - Integrate CHAs in public system - Improve supply chain infrastructure - Install quality measures - Collect premium for extended benefit package

12 Coordinated financing and implementing The government is driving toward joint financing and implementation system Now Future Implementation Technical working groups for priority thematic areas Joint Program Management Unit (JCPU) Resource alignment, pooling Virtual alignment and pooling through resource mapping Expansion of Health Sector Pool Fund (real pooling) 9 Monitoring, reporting Joint monitoring of RMNCAH Investment Case + separate monitoring by donors Single monitoring and reporting under the Pool Fund

13 Coordinated financing and implementing Donor and domestic resources were mapped and aligned to the Investment Case RMNCAH IC resource mapping ( ) Total: US$719 Million RMNCAH IC would require US$719 million in the next five years, with a US$215 million (30%) financing gap. Domestic resources is estimated to be about US$201 million (28% of total cost)

14 Coordinated financing and implementing Resource gaps have been identified and addressed Example: Resource monitoring for the community health assistant (CHA) program * * Funding Available Funding Likely Funding Shortfall Grand Bassa has not begun CHA recruitment & has no committed funding * * Rivercess deployed 269 CHAs, but philanthropic funding will exhaust by early 2018 Map is broken down to district level and implementation progress monitored Helps the MOH and partners to keep track of and address financing gaps

15 Learning Joint monitoring system for RMNCAH Investment Case was established using existing country system National Level Platform Led by Dep. Minister Planning Health Coordination Committee (HCC) Health Sector Coordination Committee (HSCC) RMNCAH IC Financiers meetings FHD representation at committees County Health Development Committee Multi-sectoral Committee (Adolescent Health) RHTC,SCM,CRVS,HFU, Community Health, etc. County Level Platform Health Facility Management Committee 16 Community Health Development Committee

16 Learning Joint monitoring indicators for RMNCAH Investment Case Strengthening CRVS systems MNDSR Sustainable Community Engagement EmONC including ANC& PNC % of Deaths Registered Will focus on 3 counties % of Births Registered % of maternal deaths with verbal autopsy conducted % of Maternal & Newborn deaths with review reports % of Maternal & Newborn deaths with review reports Number of Pregnant women referred to Health Facilities Number of catchment households visited % of CHAs trained in Module 1&2 Incidence of Stock outs of essential RMNCAH Commodities % of Births attended by a skilled health Professional Proportion of mothers who received PNC within 6 days Proportion of Babies who received PNC within 6 days ORT treatment for Under 5 Proportion of pregnant women with ANC 4+ Visits HIV Positive mothers receiving ART CYP % of facilities trained & Equipped for post abortion Care by location Adolescent Health % of health workers trained in adolescent friendly service delivery CPR Teenage Pregnancy rate, Comprehensive median age at first birth program in one county Number of peer educator meetings held

17 Outline Liberia Context How the GFF works in Liberia (so far) Reflections 16 Presentation Title

18 Personal reflection on key value-add of GFF Establish a country-owned platform where all actors jointly prioritize, align finance, implement, monitor, and be held accountable for results Make reforms of health systems and health financing integrated Facilitate (and stretch) the government, the World Bank, and others to promote the above 17

19 Key challenges Reforms with GFF requires strong government leaders how can we be less dependent on the leadership of a few individuals? Reforms with GFF requires donors to be more dynamic, flexible and transparent how can donors adapt themselves to this new operating/financing models? Multi-sector approach and partnership with the private sector, though it is a critical element of GFF, have not been advanced yet in Liberia how can we strengthen them? 18

20 THANK YOU! (WB-MOH Joint Minister s Conference Room) Country Case Study GFF Work for Liberia Shun Mabuchi Country Health Team Leader The World Bank With contribution from MoH team