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.
- Since the political crisis of August 2021, the GFF has been working closely with the World Bank and other partners to restore access to essential health services for women, children, and adolescents. These efforts include support to the World Bank to rapidly prepare the Health Emergency Response (HER) Project which is co-financed by the Afghanistan Reconstruction Trust Fund (ARTF) and the GFF Trust Fund.
- The GFF is also supporting Health Strategic Technical Working Groups (H-STWG co-chaired by WHO, World Bank, and USAID) by providing the secretariat function and facilitating the development of the Health Sector Transitional Strategy (HSTS). HSTS seeks to minimize avoidable morbidity and mortality by expanding the coverage of quality health and nutrition services and strengthen health system resilience. The H-STWG and the HSTS will be critical for improving alignment, including with humanitarian actors.
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-19 pandemic forced several countries to cancel or re-schedule plans for survey data collection these past two years.
The GFF highlights progress between the two most recent point estimates from population-based surveys approved by countries. The timing of the data points is dependent on when survey data are available, which introduces lags. In addition, it has been demonstrated that stillbirths tend to be under-reported in population based surveys1. For many of the indicators highlighted in this table, annual estimates are produced through global processes. The globally produced estimates can be found through the following sites:
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.
Survey and Estimated RMNCAH-N Coverage
The RMNCAH-N coverage data includes a standard set of 9 RMNCAH-N coverage indicators from available population-based surveys from 2010 to the most recent available survey. 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 2020, Afghanistan published data from a resource mapping exercise that captured actual health resources available for fiscal year (FY) 2018/19 and forward-looking budgets for FY 2020/21 for the government and development partners captured. The mapping 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. The resource mapping noted a significant portion of funding for health was on-budget (62%) in aggregate. However, allocations of these budgets varied significantly across provinces. The report also highlighted several key recommendations including suggestions to: 1) move from off-budget to on-plan is key to facilitate alignment and allocative efficiency; 2) revise resource allocation between provinces in order to achieve health sector strategic goals; 3) efforts should be made to regularly conduct annual resource mapping exercises and work to better understand expenditure patterns; and 4) expand the resource mapping effort in the health sector to include humanitarian assistance directed at health priorities. Since the change of government in 2021, it is unclear whether any of these recommendations have been taken forward. In the current situation in 2022, development partners, led by WHO, are working to jointly conduct a resource mapping of development partner funds and humanitarian assistance to ensure alignment of health sector support.
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-19 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.