GLOBAL FINANCING FACILITY IN SUPPORT OF EVERY WOMEN EVERY CHILD. Presented to WHO GCM/NCD Ingvar Theo Olsen, Norad 7 May 2015

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1 GLOBAL FINANCING FACILITY IN SUPPORT OF EVERY WOMEN EVERY CHILD Presented to WHO GCM/NCD Ingvar Theo Olsen, Norad 7 May 2015

2 Agenda Background to the GFF Why: The Need and the Vision What: Smart, Scaled, and Sustainable Financing for Results How: Key Approaches to Deliver Results Who: The Country Platform The GFF Trust Fund 2

3 Agenda Background to the GFF Why: The Need and the Vision What: Smart, Scaled, and Sustainable Financing for Results How: Key Approaches to Deliver Results Who: The Country Platform The GFF Trust Fund 3

4 Health related ODA quadrupled in two decades 4

5 Background : A number of global initiatives and funds established in support of the health related MDGs. Established partly as a response to weaknesses of bilateral, multilateral agencies in delivering results: Global Initiatives: The Global Strategy for EVEC, PMNCH, GHWA, Stop TB, Roll Back Malaria, UN commissions (UNCoIA, UNCoLS), Global funds: Gavi, GFATM Innovative financing mechanisms: IFFIm, AMC, UNITAID, : Countries graduating from LIC to LMIC, reduced donor funding from bi- and multilaterals, as well as Gavi and GFATM Need to ensure increased long term domestic funding (Private/public) for RMNCAH to avoid fall back Goal: The Global Financing Facility for EWEC aims to reduce inefficiency in health spendingover time, ultimately resulting in a reduction of the resource needs for RMNCAH of approximately 15% by 2030, which would lower the resources required by more than US$6 billion per year. Pathfinder for the Financing for Development (FfD), Addis Ababa July

6 Agenda Background to the GFF Why: The Need and the Vision What: Smart, Scaled, and Sustainable Financing for Results How: Key Approaches to Deliver Results Who: The Country Platform The GFF Trust Fund 6

7 Why: Global momentum to accelerate progress in RMNCAH Under-five mortality rate (per 1,000 live births) Maternal mortality ratio (deaths per 100,000 live births) Reduction in <5 mortality rate: from 90 deaths per 1,000 live births in 1990 to 46 in 2013 (40% are newborns) Reduction in MMR: from 380 deaths per 100,000 live births in 1990 to 210 deaths in % of all births are to girls aged years; complications linked to pregnancy and childbirth second most common cause of death 7

8 but challenges remain MDG 4 and 5 unfinished agenda Large remaining funding gap significant additional investments from both domestic and international resources needed Equitable and sustained progress under threat as countries transition from low- to middle-income status Inefficiencies in RMNCAH investments due to poor targeting and fragmented financing Poor state of civil registration and vital statistics systems (CRVS) 8

9 The GFF is part of a broader global effort Financing for Development agenda Development of the Sustainable Development Goals, with the unfinished business of MDG s 4 and 5 being a key priority Dialogue amongst global financing institutions about graduation and financial sustainability in the development continuum Renewal of the Every Woman Every Child Strategy GFF aims to mobilize additional USD 57 billion by

10 The ultimate goal of the GFF is to drive achievement of the SDGs End preventable deaths and improve the quality of life of women, children and adolescents by significantly scaling sustainable investments in RMNCAH Between , scale up in high burden countries could prevent up to: 4 million maternal deaths 101 million child deaths 21 million stillbirths 10

11 Agenda Background to the GFF Why: The Need and the Vision What: Smart, Scaled, and Sustainable Financing for Results How: Key Approaches to Deliver Results Who: The Country Platform The GFF Trust Fund Governance Timeline 11

12 What: Smart, scaled, and sustainable financing for results Focus on evidence-based, high impact interventions and results Smart Maintain RMNCAH results through domestic financing Sustainable Results Scaled Finance RMNCAH at scale through significantly increased domestic and international financing 12

13 Smart: Best buy interventions cut across sectors Service delivery approaches End preventable maternal and child deaths and improve the health and quality of life of women, children, and adolescents Clinical service delivery and preventive interventions Health systems strengthening Multisectoral approaches 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) 13

14 Scaled: Achieving financing at scale is critical to reaching 2030 targets for RMNCAH Approach begins by understanding the gap between resource needs and those available The GFF works to close the funding gap by improving efficiencies (which reduces the resource needs), and mobilizing resources from three key sources: 1. Domestic financing (public and private) 2. GFF Trust Fund and IDA/IBRD resources 3. Additional donor resources (e.g., Gavi, Global Fund, bilateral assistance) 14

15 Sustainable: Ensuring sustainable provision of scaled-up RMNCAH results Expenditure on health Governance, social and political change Health system development Development assistance for health Disease burden change Total Government To promote sustainability the GFF supports countries around all three health financing functions: Domestic resource mobilization Risk pooling Purchasing Economic development LIC LMIC UMIC HIC 15

16 Projected GFF impacts If the GFF is fully financed, it will achieve significant impacts: Improving efficiency by approximately 15% in 2030, resulting in a reduction of the resources needed by more than US$6 billion per year in 2030 Mobilizing a cumulative total of more than US$57 billion total 2015 and 2030 as a result of crowding-in domestic resources and by attracting new external support and improving coordination of existing assistance Supporting ~20 countries to graduate from needing external assistance for health to fully financing their national RMNCAH responses from domestic resources The combined effects of these would prevent million deaths of women, adolescents, and children by 2030 (including the stillbirths that would be averted as a result of family planning) 16

17 Agenda Background to the GFF Why: The Need and the Vision What: Smart, Scaled, and Sustainable Financing for Results How: Key Approaches to Deliver Results Who: The Country Platform The GFF Trust Fund 17

18 How: A set of synergistic approaches drives smart, scaled, and sustainable financing 1. Investment Cases for RMNCAH 2. Mobilization of financing for Investment Cases: A. Complementary financing of the Investment Case B. Increased government investment in RMNCAH C. Leveraging IDA and IBRD to increase financing for RMNCAH D. Innovative engagement of global and local private sector resources 3. Health financing strategies 4. Global public goods 18

19 1. The Investment Case High-level vision Detailed diagnosis and prioritization Consultation Core analytics Agreement on 2030 results (impactlevel) and main obstacles to be focused on Analysis by obstacle of demand, supply, enabling environment, multisectoral Agreement by obstacle on results (output/outco me level) and interventions (long- and short-term) Investment Case 19

20 National strategic framework(s) 2A. Mobilization of financing for Investment Cases: Complementary financing of the Investment Case The Investment Case sharpens the focus on evidence-based, high impact interventions while reducing gaps and overlaps as financiers increase funding for RMNCAH Government Donor 1 Donor 2 Donor 3 Private sector Government GFF Trust Fund + IDA/IBRD Donor 1 Gavi, Global Fund, other multilateral Investment Case 20

21 2C. Mobilization of financing for Investment Cases: Leveraging IDA and IBRD to increase financing for RMNCAH GFF Trust Fund designed to encourage additional allocations from IDA and IBRD by: 1. Committing grant resources only to countries that allocate IDA/IBRD financing to RMNCAH 2. Adjustable volume resources allocated from the trust fund to countries 3. Trust fund resources linked to IDA/IBRD project: Complements IDA/IBRD project rather than standalone 4. Resources can be used flexibly to provide complementary support to implementation of IDA/IBRD financing 5. Making additional trust fund resources available for countries that allocated IDA/IBRD for CRVS Based on the historic track record under the HRITF, the expected grant to IDA leverage is estimated to be 1:4 Ratio will differ significantly by country 21

22 2D. Mobilization of financing for Investment Cases: Innovative engagement of global and local private sector resources There is significant untapped potential in the private sector at the national level, including around: Service delivery Supply chain management Medical technology Access to finance Key entry points: Investment Cases and health financing strategies, both of which take mixed health systems approach Possible complementary global approaches to mobilize resources from the private sector: Health bond Special topic commitments 22

23 3. Health financing strategies Health financing assessment Comprehensive assessment: Entire health sector, not only RMNCAH Both public and private Historical trends and forward-looking projections Efficiency and equity Health financing strategy Long-term vision for sustainability of financing for 2030 targets: Domestic resource mobilization Risk pooling Purchasing Implementation, including capacity building Costed implementation plans to facilitate implementation: Based on national planning cycles and ideally in tandem with Investment Case (3-5 years) Includes capacity building and institution strengthening Sustainable provision of scaled-up RMNCAH results 23

24 4. Global Public Goods Definition: non-excludable, non-rivalrous, benefiting multiple countries Initial phase: Build on existing HRITF experience with evaluation and knowledge management CRVS Center of Excellence Subsequent phase: specific initiatives to be defined within these broad categories: Knowledge, learning, and evaluation Data and information systems Commodities Innovation 24

25 Agenda Background to the GFF Why: The Need and the Vision What: Smart, Scaled, and Sustainable Financing for Results How: Key Approaches to Deliver Results Who: The Country Platform The GFF Trust Fund 25

26 Who: the country platform Partners Approach Roles Government Civil society (notfor-profit) Private sector Affected populations Multilateral and bilateral agencies Technical agencies (H4+ and others) 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 Preparation and finalization of Investment Case and health financing strategies Complementary financing Coordination of technical assistance and implementation support Coordination of monitoring and evaluation 26

27 Agenda Background to the GFF Why: The Need and the Vision What: Smart, Scaled, and Sustainable Financing for Results How: Key Approaches to Deliver Results Who: The Country Platform The GFF Trust Fund 27

28 GFF Trust Fund Eligibility 63 low and lower-middle income countries Must be willing to commit to increasing domestic resource mobilization and to using IDA/IBRD for RMNCAH Resource allocation Three criteria: need, population, income Range of US$10-60 million per country No repartition by issues/target population CRVS fully integrated but additional funding of up to US$10 million if country includes in Investment Case and uses IDA/IBRD Roll-out $800 million pledged to date Four frontrunner countries (DRC, Ethiopia, Kenya, Tanzania) Additional 5-10 countries to be selected as a next step Operational approach Fully integrated with IDA/IBRD, as in HRITF 28

29 Agenda Why: The Need and the Vision What: Smart, Scaled, and Sustainable Financing for Results How: Key Approaches to Deliver Results Who: The Country Platform The GFF Trust Fund Relevance of GFF to NCDs Discussion points 29

30 Relevance of GFF to NCDs Discussion points: 1. The SDGs is less of an aid agenda than the MDGS - how is the area of NCDs similar to and different from RMNCAH 2. Which interventions need to happen re NCDs and what should be funded by governments, private sector and ODA? e.g. regulating tobacco and trade, funding tertiary vs primary services, innovations, PDPs, global public goods, etc. Geographical focus Africa, Asia, Cobenefits with climate, dietary sector, etc. 3. Given private sector is already more concerned with NCDs, how can it be leveraged to increase effectiveness 30