Global Health Aid Architecture

From international agenda setting todomestic resource mobilisation

In store for you

• SDG’s

• THE GLOBAL STRATEGY FOR WOMEN’S, CHILDREN’S AND ADOLESCENTS’ HEALTH

• FINANCING

• GLOBAL FINANCING FACILITY: GFF

If you google MDG images.

If you google SDG images.

Sustainable Development Goals

Universality: leave no-one,

no-where behind.

Near complete.

Global Goals

Global Goals: the next 15 years1. No poverty2. Zero hunger3. Good health4. Quality education5. Gender equality6. Clean water and sanitation7. Affordable and clean energy8. Decent work and economic growth9. Industry innovation and infrastructure10.Reduced inequality11.Sustainable cities and communities12.Responsible consumption13.Climate action14.Life below water15.Life on land16.Peace and justice17.Partnerships for the goals

Global goals SRHRGoal 3: Ensure healthy lives and promote well being for all at all ages• 3.1 By 2030, reduce the global maternal mortality ratio to less than 70 per

100,000 births. • 3.7 By 2030, ensure universal access to sexual and reproductive health care

services, including for family planning, information and education, and the integration of reproductive health into national strategies and programmes.

• 3.8 Achieve universal health coverage, including financial risk protection, access to quality essential health care services and access to safe, effective, quality and affordable essential medicines and vaccines for all.

Goal 4: Ensure inclusive and equitable quality education and promote lifelong learning opportunities for all• 4.7 By 2030, ensure that all learners acquire the knowledge and skills

needed to promote sustainable development, including, among others, through education for sustainable development and sustainable lifestyles, human rights, gender equality, promotion of a culture of peace and non-violence, global citizenship and appreciation of cultural diversity and of culture’s contribution to sustainable development.

Goal 5: Achieve gender equality and empower all women and girls• 5.6. Ensure universal access to sexual and reproductive health and

reproductive rights as agreed in accordance with the Programme of Action of the International Conference on Population and Development and the Beijing Platform for Action and the outcome documents of their review conferences.

http://www.conceptfoundation.org/wp-content/uploads/2015/11/SDGs-SRHR-and-Concept-Foundation-Overview-SDG-colors.pdf

Good health & well-beingBy 2030:• Global maternal mortality ratio: < 70/100,000 live births.• Ensure universal access to sexual and reproductive health-care.• End preventable deaths newborns/U5’s. All countries:

– Neonatal mortality: ≤ 12/1,000 live births.– Under-5 mortality: ≤ 25/1,000 live births.

• End communicable diseases.• Reduce by 1/3 premature non-communicable mortality, promote mental health and

well-being.• Strengthen the prevention and treatment of substance abuse.• Achieve universal health coverage.• Substantially reduce mortality and morbidity from hazardous chemicals, pollution and

contamination.• Strengthen WHO Framework Convention on Tobacco Control in all countries, as

appropriate.• Support R&D vaccines and medicines, that primarily affect developing countries,

provide access to affordable essential medicines and vaccines.• Substantially improve Human Resources for Health.• Strengthen the capacity of all countries to deal with national and global health risks.By 2020:• By 2020, halve the number of global deaths and injuries from road traffic accidents.

THE GLOBAL STRATEGYFOR WOMEN’S, CHILDREN’SAND ADOLESCENTS’ HEALTH

(2016-2030)• An end to preventable maternal, newborn, child and adolescent

deaths and stillbirths.

• At least a 10-fold return on investments in the health and nutrition of women, children and adolescents through better educational attainments, workforce participation and social contributions.

• At least US$100 billion in demographic dividends from investments in early childhood and adolescent health and development.

• A “grand convergence” in health, giving all women, children and adolescents an equal chance to survive and thrive.

ElementsConnected

SDG’sGlobal

Strategy

EWEC

Every Woman Every Child: Global Leader movement led by the UN Secretary General

ElementsConnected

PMNCH SDG’sGlobal

Strategy

EWEC

The Partnership for Maternal, Newborn, Child

and Adolescent Health

PMNCH constituencies: over 700 member organisations

• Healthcare Professional Associations• Academic, Research and Training Institutions• Donors and Foundations• Non-governmental Organizations• Private Sector• Multilateral Agencies/International Organizations• Partner Countries

• Finding a place for Youth

ElementsConnected

PMNCH SDG’sGlobal

Strategy

GFF

EWEC

The Global Financing Facility

ElementsConnected

PMNCH SDG’sGlobal

Strategy

GFF

EWEC

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

Sourced from WB, incl. personal communication

2015 2020 2025 2030

ODA

ODA

Domestic resources

Long term financial sustainability

Sourced from WB, incl. personal communication

Sustainable: Ensuring sustainable provision of scaled-up RMNCAH results

UMIC HIC

Government

Disease burden change

Economic development

Development assistance for

health

LMICLIC

Exp

end

itu

re o

n h

ealt

h

Health system development

Total

Governance, social and political change

Approach begins with an understanding of the gap between resource needs and those available for RMNCAHThe GFF works to close the funding gap by mobilizing domestic resources from both public and private sectors. Financing is mobilized from three key sources:

• Domestic financing (public and private)

• GFF Trust Fund and IDA/IBRD resources

• Additional donor resources

Sourced from WB, incl. personal communication

Investment Case

GFF Investors Group

Trust Fund Committee

GFF Trust Fund

UNSG High Level Champions Group

GFF Secre-tariat

PMNCH

World Bank Board

Structurally linked governance of GFF financing facility and of GFF TF

• GFF Investors Group leads governance of multi-stakeholder financing partnership to ensure effective co-financing of RMNCAH investment cases in GFF countries (Function 1)

• GFF TF Committee: subset of the Council (TF donors) with devolved decision-making on GFF TF allocations (Function 2)

• GFF Secretariat manages TF and provides support to Council and TF committee

• WB Board: final commitment of TF and IDA resources; fiduciary oversight

• PMNCH leads global advocacy and accountability on Global Strategy/EWEC; conducts broader stakeholder engagement around GFF

• UNSG Champions Group would include GFF as a key financing platform for Global Strategy

Quality assured, nationally-owned, multi-stakeholder

process following IHP+ principlesal

ign

ed c

o-i

nve

stm

ents +IDA

Basic structure agreed upon; discussions ongoing on interfaces between structures

GFF setup

Sourced from WB, incl. personal communication

Smart: “best buy” interventions cutacross sectors

Clinical service delivery and preventive interventions

Health systems strengthening

Multisectoralapproaches

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

Serv

ice

de

live

ry

app

roac

he

s

CRVS

Equity, gender, and rightsMainstreamed across areas

• Prioritizes interventions with a strong evidence base demonstrating impact• Further focuses on improved service delivery to ensure an efficient national

response, such as through:• Task-shifting• Integration of service delivery• Community health workers• Range of factors influencing private sector service delivery Sourced from WB, incl.

personal communication

Leverage

GFF $2,6 billion as a first step to help close the $33,3billion annual funding gap for reproductive, maternal,

newborn, child and adolescent health”.• IDA (International Development Assistance) credit:

• GFF x4– Earmarking IDA?

– Linking, but not tying…: “All grant funding is linked to IDA resources (using the regular country led demand based model for IDA)”

• IBRD (International Bank for Reconstruction & Development) loan:

• GFF x3-5– Who provides the required guarantee?

– “The IBRD funding for IDA countries is under discussion but there has not been any decision about this.”

• Private investors bying into Social Investment Bonds (SIB’s):– Achieve today with tomorrow’s money

– Shared risk, need for robust monitoring and evaluation

– Complex partnerships/contractsSourced from WB, incl.

personal communication

Countries leading the way

• Frontrunners: DRC, Ethiopia, Kenya and Tanzania

• Second wave: Bangladesh, Cameroon, India, Liberia, Mozambique, Nigeria, Senegal, and Uganda

Sourced from WB, incl. personal communication

GFF governance at the country level: the country platform

• Preparation and finalization of Investment Case and health financing strategies

• Complementaryfinancing

• 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)

ApproachPartners Roles

Sourced from WB, incl. personal communication

GFF Trust Fund

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

Foundation.

• Country selection:– Eligibility: 62 low and lower-middle income countries: LIC & LMIC.

• 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.

Sourced from WB, incl. personal communication

And … don’t forget OOP

Out Of Pocket

= public + donor + insurance + private

National Out of Pocket% of Total Health Expenditure

0 10 20 30 40 50 60 70 80

Sudan

Georgia

Sao Tome and Principe

Philippines

Syrian Arab Republic

Viet Nam

Nepal

Kenya

Saint Lucia

Dominican Republic

Iraq

Peru

Lithuania

Bahamas

Zambia

Belize

Angola

Congo

Saudi Arabia

Andorra

Sweden

Lesotho

Croatia

San Marino

Cook Islands

Vanuatu

Botswana

OOP 2013National Health Accounts WHO

OOP = 50% THE

> 50%

< 50%