The GFF’s Catalytic Role
The GFF Catalytic Role provides details on the GFF support for Cameroon’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.
- Developing a costed and prioritized investment case: Revised in September 2020, Cameroon’s investment case (IC) focuses on scaling up results-based financing (RBF) in disadvantaged regions to improve equity in spending, incentivizing birth registration through performance-based financing, and strengthening kangaroo mother care to improve the management of low birthweight and/or preterm infants in order to reduce neonatal mortality through a development impact bond. High-impact interventions have already contributed to reducing maternal mortality. The COVID-19 pandemic has, however, disrupted health services and affected IC implementation.
- Prioritizing and implementing health financing and systems reforms: To increase efficiency and move more resources to frontline services, the IC supports reforms to expand RBF for primary health care, along with a voucher scheme to increase demand for services. Through training and technical assistance, the GFF supports finalizing the health financing strategy, enhancing domestic resource mobilization, and developing a roadmap for universal health care, including scaling up RBF at the central level. The GFF also seeks to strengthen pharmaceutical regulations and the drugs supply chain.
- Strengthening the country platform and convening financial and technical partners at country level: The GFF serves as a catalyst for leveraging partnerships to support IC implementation. Existing tools and frameworks between institutions intend to facilitate alignment as well as ongoing discussions and negotiations. The resource mapping and expenditure tracking exercise conducted in 2020 revealed a funding gap of 57.3 percent for the period Change to 2017- 2022 for implementing the IC.
- Improving data for decision making: The GFF supports strengthening the country’s health management information system and data quality through workshops and investment in equipment. The RBF project promotes the use of quality data at the primary care and district levels. Creation of accessible dashboards that visualize country and program-level data across output, outcome, and impact indicators to enhance data use is under way. Ongoing efforts are improving the interoperability of the RBF and national online health information system (DHIS2). The GFF supports monitoring the use of essential health services in times of COVID-19.
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 Cameroon team collaborated with Countdown to 2030 and GFF in an analysis workshop in Nairobi, Kenya, on 13-17 June 2022. As a result of that workshop, the team produced a report analyzing data quality and estimating coverage of key service delivery indicators. Please find the final report here.
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.
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.
A detailed resource mapping and expenditure tracking exercise (RMET) was conducted in Cameroon, based on the four RMNCH priorities identified in the 2017–22 investment case (IC). The objective was to analyze the evolution of the resources committed by the government of Cameroon and its partners to these health priorities, and to determine the funding gap to be filled through better alignment of external aid and increased mobilization of domestic funding. The RMET shows gaps by priority, but also subnational region. Despite a fairly large number of 25 partners funding the IC priorities, a financing gap of 57% of the total cost over four years remains (the gap is 49% in 2020, as shown in the graphic). Mobilization of both domestic and external funding towards RMNCH priorities is critical, particularly in light of the high out-of-pocket spending, which accounts for over 70% of current health expenditure in Cameroon.
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-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.