The GFF’s Catalytic Role
The GFF Catalytic Role provides details on the GFF support for Afghanistan’s Reproductive, Maternal, Neonatal, Child, and Adolescent Health and Nutrition (RMNCAH-N) agenda. Details on past and ongoing work are provided along with plans for future support. The GFF Catalytic Role focuses on support provided in the areas of the Investment Case (IC), Health Financing and systems reforms, the country platform, partner alignment, and data use for decision-making.
- The GFF’s engagement in Afghanistan began in 2015 with a focus on transforming the country’s health service delivery model to expand access to quality care in most provinces, while also improving accountability and resource efficiency. Support from the GFF, World Bank, and other partners had contributed to improvements in several core maternal and child health indicators, such as more attended births, improved access for women and girls to contraceptives, and increased antenatal and postnatal care.
- Building on this progress, in 2020, the GFF supported the expansion of Afghanistan’s investment case to better align initiatives financed by other partners and increase the share of health resources around priorities. However, the recent security events in Afghanistan, coupled with the impacts of the COVID-19 pandemic are threatening more than two decades of health progress, calling for a refocused GFF approach.
- The GFF is working closely with the World Bank and other development partners to understand the implications of the current crises on the health system and ways to ensure (a) continuation of the current NGO-based service delivery model; (b) the ability of women and girls to access services, and for female healthcare workers to safely support service delivery in communities; (c) mitigation of medical supply chain disruptions and economic shocks affecting households’ ability to pay for care.
Core RMNCAH-N Impact Indicators
The 8 GFF core impact indicators reflect updates aligned with the in-country survey schedule which optimally occurs once every three to five years to determine population-based changes in important health and nutrition outcomes. These indicators are core to the GFF Logic Model, to reflect impact of aligned interventions over time. Collected by governments and development partners, these indicators are also used to monitor the Every Woman Every Child Initiative and the 2030 Sustainable Development Goals (SDGs) for RMNCAH-N. The country survey data includes Demographic Health Surveys (DHS) and Multiple Indicator Cluster Surveys (MICS), which are funded by domestic resources as well as by the World Health Organization (WHO), UNICEF, USAID and other multi- and bilateral organizations. The Covid pandemic forced several countries to cancel or re-schedule plans for survey data collection in 2020.
Core Health Financing Indicators
The six GFF core health financing indicators track changes to country budget and expenditures with a focus on health spending, to monitor the expected impact of increasing the total volume and value of funding allocated to health and nutrition. The GFF partnership supports financing reforms by engaging with ministries of finance and ministries of health to strengthen mobilization of domestic resources as well as allocative and technical efficiency. These indicators are tracked through country-specific data sources such as BOOST, NHA, and budget reports. Expenditure data are tracked through the Global Health Expenditure Database (GHED), for which data are available through the end of 2018. Through measurement of budgets and expenditures, the GFF partnership aims to accelerate the expansion of interventions that are high-impact, cost-effective, affordable, and feasible to accelerate progress on universal health coverage and in achieving SDG targets.
Population-Based Survey Coverage Indicators
The RMNCAH-N coverage data includes a standard set of 9 RMNCAH-N coverage indicators from available population-based surveys from 2010 to 2020. These indicators show progress towards key goals across maternal, child, and adolescent health and nutrition outcomes. Additional key nutrition-specific and/or education-specific coverage indicators are presented for countries where the GFF co-finances a nutrition-focused World Bank project or where education is a strong focus of the IC.
The RMNCAH-N coverage data are sourced from the most recent available population-based surveys. Data on immunization are presented from the WHO/UNICEF joint reporting process and recent population-based surveys.
In Afghanistan, coverage of core RMNCAH-N indicators has shown improvement over the most recent decade, with particular gains in maternal health indicators including skilled attendant at delivery and institutional deliveries.
Resource mapping is a key component of the GFF approach. The resource mapping exercise helps countries assess funding gaps, align donor and government resources, and improve the efficiency and equity of health spending. Resource mapping data for each country varies based on whether countries have completed one or more resource mapping exercises.
In Afghanistan, a resource mapping exercise was commissioned to support health budget alignment and harmonization and take stock of both on- and off-budget health resources at national and subnational levels. A critical takeaway of the resource mapping is that a significant portion of funding for health is on-budget (62%), with the government contributing approximately 5% of the overall funding. The key findings of this exercise will help the Ministry of Public Health (MOPH) and its international partners make informed decisions in ongoing and future planning and budgeting process, support with updating the investment case (IC) for Afghanistan, and promote alignment, coordination, and efficiency in the use of scarce resources. Mapping for the government and development partners captured actual health resources available for fiscal year (FY) 2018/19 and forward-looking budgets for FY 2020/21. The MOPH is currently finalizing costing of the IC, which will allow calculation of the funding gap for the overall health sector as well as by specific IC priority.
Monitoring The Country-led Process
The GFF Logic Model highlights key elements of a GFF co-financed country-led process that contribute to the expected impact of improved RMNCAH-N outcomes over time. The GFF has developed a core set of indicators to monitor implementation of the GFF approach, considered as inputs and activities in the model, that emphasize prioritization and alignment to capitalize on efficiencies to improve transparency and accountability as well as health outcomes. Process monitoring includes tracking investment case development, country stakeholder engagement, health financing and the inclusion of gender and equity approaches.
The data in this section is provided for a selection of indicators from the Investment Case Results Framework, Health Financing priorities, and the World Bank Project as applicable. Please select indicators from the dropdown menu to view the data for each indicator. Where subnational data is available, the map will display subnational trends over time or the latest data available. Hovering over the map will display additional data for the select indicator. Clicking on a region will add it to the chart on the right. All data, including source information, may be downloaded by selecting the arrow to the right of the indicator dropdown menu.
Monitoring of Essential Health Services
The GFF supports routine monitoring of disruptions to essential health services. The essential health services data included in the graph below are sourced from country routine health information systems and shown monthly starting at the beginning of 2020. The analysis compared the observed service volume to what would have been expected had the pandemic not occurred, and reports the difference as a percentage. Positive values indicate a surplus of services, 0 indicates the expected level of services, and negative values indicate a lower volume than expected based on pre-pandemic values. In some countries, these changes in volume could be due to non-COVID reasons.
The number of monthly deaths from Covid-19 is reported as a measure of the pandemic’s reach. The data on deaths from the Covid-19 pandemic were sourced from Johns Hopkins University (JHU) dashboards and compiled into monthly aggregates. The data used in this report were sourced 8/24/2021.