The GFF’s Catalytic Role
The GFF Catalytic Role provides details on the GFF support for Chad’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 investment case (IC) for Chad is still under development with some delays as a result of the COVID-19 pandemic and political instability. A situation analysis has been completed and an early draft theory of change developed. The GFF and partners have provided technical assistance to conduct a bottlenecks analysis using the Equist tool, along with IC costing using the One Health tool.
- Prioritizing and implementing health financing and systems reforms: The GFF supports enhancing the public finance management system and provides technical assistance for a public expenditure review and a review of fiscal space to increase domestic resource utilization and mobilization. To facilitate this, an initial resource mapping and expenditure tracking exercise has been completed. The IC process also involves a feasibility analysis of pooling mechanisms and supports the institutionalization of results-based financing (RBF), to include strengthening the community health worker program. The GFF supports improving equity through free health care and health insurance for the poorest.
- Strengthening the country platform and convening financing and technical partners at country level: The GFF is supporting capacity building and providing funding to civil society organizations to strengthen their involvement in IC development and implementation, while also engaging with potential new partners interested in joining the IC. The country platform conducted learning activities on stakeholder engagement, IC development and implementation, and maintenance of essential health services in the COVID-19 context.
- Improving data for decision making: The GFF supports the ongoing development of a clear IC results framework with baselines and targets, which included an assessment of data availability and quality. Reforms aim to strengthen the civil registration and vital statistics system and enhance data collection and use by the country platform. As part of the RBF program, data on quality of care will be regularly collected and analyzed and data gaps will be assessed. A phone survey to monitor essential health services during the COVID-19 pandemic is ongoing.
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 Chad 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.
The first resource mapping and expenditure tracking (RMET) exercise was completed in May 2021 and covered the period from 2018 to 2021. As the investment case (IC) is under development, the RMET focused on the priorities of the National Health Development Plan (PNDS 3).
The exercise helped identify available resources from 26 donors (76%). The largest financial contributions are provided by the Global Fund (23%), USAID (12%), UNICEF (12%), EU (7%), Gavi (10%), WB/IDA (6%) and AFD (6%), with funding completed by the government budget (24%). The decrease in funding planned from the year 2021 is partly explained by the lack of predictability of future commitments from both the government and donor partners.
Overall, the combined budgetary commitments of donors and the government over the period from 2018 to 2022 (and beyond) for the RMNCAH and for nutrition were respectively 19% and 19.4% of total resources allocated to the health sector. Notably, the said commitments have increased over the last three years, from 2018 to 2020, by 85.6% for the RMNCAH and by 24.1% for nutrition.
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.