The GFF’s Catalytic Role
The GFF Catalytic Role provides details on the GFF support for Cote d'Ivoire’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 of a costed and prioritized investment case: The investment case (IC) for Cote d’Ivoire has helped mobilize and align development partners around health financing priorities, which include increasing public spending on primary health care through decentralization, strengthening integration of private and public health sector, scaling up strategic purchasing to move more resources to the frontlines, and linking the universal health insurance scheme with evidence-based tools to track progress.
- Prioritizing and implementing health financing and system reforms: The IC prioritizes to enhance equity and quality of services purchased through insurance and the effectiveness of the targeted free healthcare system. The government is well on its way to a nation-wide scale up strategic purchasing and performance-based financing of the public health care providers. Increased efforts to align the private sector health care providers with GFF support is underway.
- Strengthening the country platform and convening financial and technical partners at country level: In 2019, the government established the National Platform for the Coordination of Health Financing. Involving a broad range of partners, the platform supports implementation of health financing reforms and ensures adequate and sustainable funding of the health sector when development partners transition out of the country. For better alignment on priorities, the GFF provided human resources to lead the development partners’ technical working group on health financing, and ensured technical assistance to the private sector and civil society.
- Improving data for decision making: Cote d’Ivoire has quality data available, so GFF efforts so far have focused on alignment of methods to track primary health care financing and the monitoring of the IC priorities. Additional efforts to include private health sector data is underway. Cote d’Ivoire also benefit from support of the Countdown2030.
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 CIV 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 investment case process in Cote d’Ivoire has been central to obtaining government engagement to increase its yearly health budget, which increased by 16.6% between 2019 and 2020. Based on the government budget increase and resource mapping data collected among donors, the investment funding gap was reduced by 50% between 2020 and 2021, from 57% in 2020 to 34% in 2021. From this year on, the Ministry of Health and Public Hygiene will be in charge of rolling out the RMET exercise through the Directorate of Financial Affairs, which will be working on the integrating of RMET with the National Health Accounts.
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.