The GFF’s Catalytic Role
The GFF Catalytic Role provides details on the GFF support for Central African Republic’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.
- Development and update of a prioritized and costed investment case: the GFF supported the development and subsequent update of a government-led Investment Case (IC) focused on high-impact interventions and multisectoral mobilization. Strong government commitment to prioritization has reduced the number of interventions and improved geographical targeting, and it has led not only to the development of a community health worker strategy document, but also to roadmaps for the private sector and civil society organizations (CSOs).
- Prioritization and implementation of health financing and systems reforms: the IC aims to improve the efficiency of health spending by institutionalizing resource mapping and expenditure tracking and to support quality health service delivery through results-based financing and capacity-building of community health workers. With the support of the GFF, the government has reviewed the organizational structure of the Ministry of Health to incorporate a health financing coordination unit, in order to improve the mobilization and use of resources. In addition, the daily use of the Geo-Enabling for Monitoring and Supervision (GEMS) system has greatly contributed to improving governance and the regular monitoring of activities.
- Strengthening of the national platform and alignment of financial and technical partners at the national level: ongoing efforts include strengthening and expanding the national platform to include more CSOs and the private sector. GFF technical assistance contributed to the establishment of an Alignment and Harmonization Sub-Committee for the Health Sector Committee. The Central African Republic has institutionalized at a national level the Alignment Programme to help mobilize donors around the national priorities described in the National Health Development Plan (PNDS III) and the Investment Case, following the principle of One Plan, One Budget and One Report. The GFF is focusing on improving data generation and use, including recommendations for new financing efforts.
- Improved data for decision-making: the GFF supported the development of a clear results framework for the Investment Case, with clear baselines and targets, as well as a monitoring system and monitoring mechanism. The government has set up a single national health management information system (HMIS) supported by a multi-partner roadmap. 55 data managers have been recruited and deployed to all regions and districts in the country, in order to support the deployment of DHIS2 which is currently underway.
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.
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.
Since joining the GFF, the Central African Republic has made RMNCAH-N a national priority, and the country is taking major steps towards achieving the Sustainable Development Goals through the development and implementation of its investment case (IC) for the reduction of maternal and child mortality. An important part of this initiative is resource mapping and expenditure tracking, which helps assess funding gaps, align donor and government resources, and improve the efficiency and equity of health spending.
Previous resource mappings and detailed costing exercises have shown that over the period covered by the CAR investment case for 2020 to 2022, financing needs amount to US$151 million. The government and funding partners have committed to supporting the implementation of the interventions prioritized in the IC, and a resource mapping exercise currently nearing completion will not only confirm the government and partner financing, but will also track expenditure on IC priorities in 2020.
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.