INTRODUCTION TO THE GLOBAL FINANCING FACILITY: A GUIDE FOR GFF ENGAGEMENT AND INCREASING FINANCING RESOURCES 1. INTRODUCTION: HOW A FINANCING C. STRENGTHENING SYSTEMS: to track progress, learn, and course-correct. FACILITY DRIVES PROGRESS TOWARD THE SDGS The GFF is a partnership that brings together a wide array of stakeholders, including national governments, civil society The Global Financing Facility in Support of Every Woman Every Child organizations, the private sector, multilateral and bilateral institutions, (GFF) is a multi-stakeholder partnership. The GFF was established and foundations. To support this broad partnership, a multi-donor trust as an innovative financing mechanism in 2015 to close the estimated fund – the GFF Trust Fund – has been established at the World Bank annual financing gap of US$33 billion1 that has hindered reaching Group to be a catalyst for this process. The GFF Trust Fund provides key Millennium Development Goals (MDGs) and that is required to flexible financing for the preparatory work and technical assistance eliminate preventable maternal and child deaths for achieving important required to identify priorities, supports the process of bringing partners Sustainable Development Goals (SDGs) by 2030. The GFF process helps together, and makes grants linked and complementary to IDA or IBRD governments and their partners to prioritize, focus on results, and tackle financing to address key priorities. The GFF Trust Fund is not intended the main systems bottlenecks to impact at scale which are critical to to fill the financing gap on its own but rather to help coordinate and achieving universal health coverage. crowd in additional resources from the broader set of partners that are part of the facility, and to build synergies and ensure that the resources Although considerable progress has been made over the past 25 years available are aligned and working smoothly together (i.e. IDA/IBRD, in improving reproductive, maternal, newborn, child, and adolescent donor funds, private sector, and public domestic resources). The GFF health and nutrition (RMNCAH-N), too many women, children, and approach is guided by two key principles: country ownership and equity. adolescents have been left behind, with MDGs 4 and 5 (child and maternal health) the furthest from attainment among all the MDGs. 2. KEY ELEMENTS OF THE GFF PROCESS The SDGs represent an ambitious international agreement for the world we want to see. This commitment has led to global conversation about The GFF process is country-led and experience of initial GFF countries how to finance development goals, which is only possible through new has led to the identification of a number of steps that have proven approaches to financing that recognize that countries themselves are useful for ensuring successful GFF engagement. the engines of progress and that the role of external assistance is to support countries both to get more results from existing resources and A. GOVERNANCE ARRANGEMENTS TO ENSURE COUNTRY to increase the total volume of financing. OWNERSHIP AND LEADERSHIP The GFF supports countries to enhance their trajectory to achieve The first step in most countries is the establishment of the country the SDGs by: platform2. Often times building on existing mechanisms, the country platform brings together a range of key stakeholders, typically A. STRENGTHENING DIALOGUE: among key stakeholders under including: different parts of the government, representatives of civil the leadership of governments and supporting the identification of society organizations, private sector and development partners (both a clear set of priority results that all partners commit their resources financiers such as bilateral donors and multilateral agencies such as to achieving; Gavi and the Global Fund, and technical agencies). B. GETTING MORE RESULTS: from existing resources and The country platform plays a number of roles, including overseeing coordinating increased total volume of financing on key RMNCAH-N the development and implementation of the Investment Case and priorities from four sources: of the health financing work, mobilizing financing for the priorities identified, coordinating technical assistance, and overseeing • Domestic government resources; monitoring and evaluation efforts. • Financing from the International Development Association (IDA) and the International Bank for Reconstruction and 1 The GFF Business Plan, 2015. Development (IBRD); 2 A guidance note on country platform is available on the GFF website: • Aligned external financing; https://www.globalfinancingfacility.org/sites/gff_new/files/GFF%20Country%20 • Private sector resources; Platform%20guidance%20note.pdf gffsecretariat@worldbank.org www.globalfinancingfacility.org @theGFF 1 GFF_UHC_EN_3-26-18.indd 1 4/11/18 7:07 AM INTRODUCTION TO THE GLOBAL FINANCING FACILITY: A GUIDE FOR GFF ENGAGEMENT AND INCREASING FINANCING RESOURCES B. STRENGTHENING DIALOGUE IN ORDER TO PRIORITIZE These investments include interventions specifically addressing AND COMMIT FINANCING key RMNCAH-N challenges; health systems strengthening required to deliver quality health services (e.g., human resources for Once governance arrangements have been worked out, the next stage health, supply chain management, health financing, or information is the planning phase: the identification of what needs to happen for systems); and multi-sectoral approaches to improve health and a country to “bend the curve” and get on a trajectory to achieving nutrition outcomes through sectors such as education and social the SDGs. This includes both the shorter-term investments that are protection. The Investment Case process should also identify required to improve the health and wellbeing of women, children, and ways to improve the efficiency of existing spending and whenever adolescents and move countries toward universal health coverage possible define the first steps needed to mobilize additional (UHC), and the longer-term reforms to health financing systems that domestic resources for health. are required to ensure the sustainability of investments and further progress towards UHC. Investment Cases also identify main bottlenecks that need to be addressed to deliver these interventions. As part of the health system bottleneck analysis, underlying issues in the health GFF CONTRIBUTION TO financing system are analyzed to determine how incentives and UNIVERSAL HEALTH COVERAGE resources need to shift to support proposed reforms and achieve suggested results in an efficient and equitable manner. • GFF supports the progressive expansion of services by LONGER-TERM REFORMS assisting countries in prioritizing and expanding the coverage of high-impact interventions for women and children—who are key populations that are often not adequately covered—through the While the Investment Case is intended to accelerate progress development of an Investment Case. now to improve health outcomes in the near-term, countries often need to undertake larger, longer-term reforms to their health • The GFF’s strong equity focus is critical to the progressive systems, particularly around health financing, to attain the SDGs. expansion of services to non-covered populations, many of The overall aim of this work is to close the financing gap for whom are poor, vulnerable and disadvantaged women and RMNCAH-N in an equitable manner and to set countries on the children. path to universal health coverage by supporting their progress • The GFF supports countries in implementing key health towards more sustainable and equitable health financing systems. financing reforms, which support domestic resource mobilization A key element of these long-term reforms is mobilizing additional and the introduction of risk-sharing schemes, which in turn domestic resources for health. Even in most low-income countries, reduces out-of-pocket expenditures. a large share of health expenditures is from domestic sources, and it is not possible to close the financing gap for RMNCAH-N or achieve UHC without increases in domestic financing. This requires both taking advantage of economic growth by growing the overall THE INVESTMENT CASE volume of government expenditures and prioritizing the health sector within the government budget. Domestic resources for The process of identifying priority investments in the short-term RMNCAH-N come from both public and private sources, although is called the development of an “Investment Case”. The objective the emphasis in the GFF approach is on shifting from forms of of the Investment Case process is to shape how resources are financing that increase inequities (particularly out-of-pocket directed: to ensure that available financing is being targeted at expenditures) toward mechanisms that do not disadvantage the a set of priority investments that will benefit women, children, poor and vulnerable. A key focus is on shifting from out-of-pocket and adolescents, and support the attainment of universal health expenditures to increased prepayment and pooling of resources coverage. The investment case builds on existing plans and for health. strategies, while supporting governments in prioritizing key reforms based on rigorous analysis of data. gffsecretariat@worldbank.org www.globalfinancingfacility.org @theGFF 2 GFF_UHC_EN_3-26-18.indd 2 4/11/18 7:07 AM INTRODUCTION TO THE GLOBAL FINANCING FACILITY: A GUIDE FOR GFF ENGAGEMENT AND INCREASING FINANCING RESOURCES C. GETTING MORE RESULTS FROM EXISTING RESOURCES AND • Domestic resources: National funding is the major source of COORDINATING INCREASED TOTAL VOLUME OF FINANCING health expenditure in most countries, with many possible ways FROM FOUR SOURCES to improve the efficiency of domestic spending and increase the volume of it. The involvement of ministries of finance is particularly Prioritization within the limits of available resources is a critical part of important in this area. the GFF approach but it is only a step along the path. The heart of the GFF approach is about making meaningful shifts towards the efficient • IDA and IBRD financing: The GFF is closely linked to IDA/IBRD use of financing and in the total volume of financing available (i.e., the country engagements and complementary operations, providing quality and quantity of financing). Ministries of Health and Finance the opportunity to increase synergies and the scale of financial investment in the health sector A core part of the GFF approach is getting more results from existing and UHC agenda. To date, resources from the GFF Trust Fund are resources and coordinating increased total volume of resources from linked with concessional financing from the World Bank Group four sources: in a ratio of US$1 from the trust fund to more than US$5 of IDA/ IBRD financing on average. The GFF support for the investment case can help strengthen the case for and effectiveness of IDA/ TABLE 1: COUNTRY PROCESS FOR GFF ENGAGEMENT IBRD country programming and intervention design. The technical AND IDA/IBRD MOBILIZATION* assistance provided as part of the GFF process has resulted in improvements in the use of existing IDA/IBRD financing and in NECESSARY ACTION RELEVANT AGENCY increased volumes of IDA/IBRD financing. MOF and MOH (or other relevant MOF, MOH ministry) express interest in • Aligned external financing: External financing is often highly participating in the GFF with a fragmented, which increases duplication and other inefficiencies commitment to increase domestic and means that crucial areas may be underfinanced. The GFF resources and allocate addresses this through the country platform and the Investment IDA/ IBRD for the GFF agenda. Case process. High level commitment to the GFF principles by key development partners also enhances coordination and Decision of GFF’s support of GFF Trust Fund Committee accountability of their country operations. This is a unique value- country selection by GFF Trust Fund Committee** added element of the GFF. Establishment of country platform and MOH to lead with MOF and preparation of the Investment Case other sectors, bilaterals, CSO’s, • Private sector resources: Private financing is a critical source private sector, WB, technical of capacity to deliver services (in many GFF countries, more agencies and GFF secretariat than half of key RMNCAH-N services are delivered by private Development of IDA/ IBRD and MOH and WB (with MOF and providers) and of financing. The GFF approach is to harness GFF TF financed projects and in consultation with country both the capacities of the private sector and to attract additional country programs based on the platform and particularly other private sector financing (particularly through innovative financing Investment Case financiers for alignment and approaches). coordination of investments) Board approval of project World Bank * The average timeline from the start of the process to WB board approval is 9 months. ** Country selection takes place based on available resources and country demand on average twice a year. GETTING MORE RESULTS gffsecretariat@worldbank.org www.globalfinancingfacility.org @theGFF 3 GFF_UHC_EN_3-26-18.indd 3 4/11/18 7:07 AM INTRODUCTION TO THE GLOBAL FINANCING FACILITY: A GUIDE FOR GFF ENGAGEMENT AND INCREASING FINANCING RESOURCES While different national contexts make it difficult to generalize steps, the table below provides concrete examples of how GFF countries have approached and taken forward health sector financing and coordination. TABLE 2. APPROACHES TO GETTING MORE RESULTS OUT OF EXISTING RESOURCES AND INCREASING THEIR TOTAL VOLUME DOMESTIC RESOURCES GETTING MORE RESULTS FROM EXISTING Improving allocative efficiency through the prioritization process of the Investment Case RESOURCES/IMPROVING EFFICIENCY (most countries as this is a main objective of GFF investment cases) Strengthening public financing management (e.g., Mozambique) Results-based financing (e.g., Tanzania) INCREASE TOTAL VOLUME Increasing the total volume of government revenue by improving the effectiveness of tax collection and/or increasing the revenue base of existing taxes Introducing new taxes/revenue sources (e.g., Liberia) Giving higher priority to health in domestic spending (e.g., Kenya) FINANCING FROM IDA/IBRD GETTING MORE RESULTS FROM EXISTING Strengthening coordination through the country platform, leading to the identification RESOURCES/IMPROVING EFFICIENCY of synergies with other development partners (e.g., Cameroon) INCREASING THE TOTAL VOLUME In DRC, the development of the Investment Case and strong country leadership led to a new OF RESOURCES IDA allocation for health of US$200 million linked to US$40 million in TF resources. Using a multi-sectoral perspective to improving health outcomes and thereby drawing in IDA/IBRD financing for other sectors (e.g., Bangladesh) Using a “buy-down” to increase IBRD financing into the health sector (e.g., Guatemala) ALIGNED EXTERNAL FINANCING GETTING MORE RESULTS FROM EXISTING Strengthening information flow among donors so that gaps and duplication in financing RESOURCES/IMPROVING EFFICIENCY can be identified and addressed (e.g., Liberia) Building operational mechanisms to increase coordination among development partners (e.g., DRC) Collaborating to strengthen government systems so that more external resources can flow through the national budget, which improves efficiency (e.g., Mozambique) INCREASING THE TOTAL Channeling newly available development assistance to the priorities identified in VOLUME OF RESOURCES the Investment Case (e.g., Cameroon) PRIVATE SECTOR GETTING MORE RESULTS FROM EXISTING Using a results-based financing approach that draws in new (non-state) actors (e.g., Nigeria) RESOURCES/IMPROVING EFFICIENCY INCREASING THE TOTAL VOLUME Employing innovative financing mechanisms (e.g., Cameroon) OF RESOURCES gffsecretariat@worldbank.org www.globalfinancingfacility.org @theGFF 4 GFF_UHC_EN_3-26-18.indd 4 4/11/18 7:07 AM