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.
- Developing a costed and prioritized investment case: The GFF supported the development of a government led investment case (IC) that focuses on high-impact interventions and multisectoral mobilization. Strong government commitment to prioritization helped narrow down the package and geographical targeting and led to the development of a community health worker strategy document and of private sector and civil society organization (CSO) road maps.
- Prioritizing and implementing health financing and systems reforms: The IC aims to improve health spending efficiency by institutionalizing resource mapping and expenditure tracking and support the delivery of quality health services through results-based financing and capacity building of community health workers. With GFF assistance, the government established a health financing coordination department to improve resources mobilization and utilization. Daily use of a geolocation monitoring and supervision system greatly contributed to improving governance and regular monitoring of activities.
- Strengthening the country platform and convening financial and technical partners at country level: Ongoing efforts are strengthening and broadening the country platform to include more CSOs. GFF technical assistance has contributed to the establishment of an active health management information systems technical working group. To help mobilize donors around the IC and institutionalize measurement of country-level alignment, the GFF is focused on improving the generation and use of data, including recommendations for new data collection efforts.
- Improving data for decision making: The GFF is providing support for the development of a clear IC results framework with baseline and targets and an IC monitoring system and a monitoring mechanism. The government set up an interagency and multipartner national health information system, staffed by data managers recruited from districts across the country.
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.
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.