The GFF’s Catalytic Role
The GFF Catalytic Role provides details on the GFF support for Ethiopia’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 supports Ethiopia’s first investment case (IC) to expand essential health services — particularly in underserved regions — by increasing human resources at the primary health care level, strengthening community mobilization, improving the supply chain, and addressing barriers to access. Up to 90 percent of the funding, linked to results, has been disbursed with GFF awarding a second round of funding to Ethiopia for US$30 million. The GFF has also supported the development of a new IC that emphasizes equity with more financial incentives at subnational levels and addresses lagging issues such as neonatal and adolescent care. The IC strengthens equity by incentivizing deliveries attended by skilled birth providers in the lowest three performing regions (Afar, Oromia, and Somali), and focused on family planning and adolescent health.
- Prioritizing and implementing health financing and health system reforms: The GFF provides analysis and policy recommendations for domestic resource utilization and mobilization for health and assisted the government in monitoring budget priorities. In parallel, the GFF plays a critical role in fostering domestic resource mobilization and resource efficiency, which is drawing donor interest to join the Sustainable Development Goals Performance Fund (SDGPF). The GFF supported the implementation of disbursement-linked indicators related to community-based health insurance, rolled out to more districts and resulting in higher utilization of care. GFF technical assistance supported the automation of the Pharmaceuticals Supply Agency’s core business process and fiduciary system to enhance efficient procurement and distribution and helped transform the civil registration and vital statistics system by transitioning to electronic registration.
- Strengthening the country platform and convening financial and technical partners at country level: The GFF partnership has played a critical role in fostering the domestic resource mobilization and efficiency agenda for Ethiopia during the SDG-PF retreat, which has attracted other donors interested in joining he SDG-PF in the coming year. The GFF has also helped strengthen engagement with the private sector through analytics, technical assistance, and building capacity to select and manage private sector initiatives and public-private partnerships. In addition, the GFF has helped crystalize alignment around key health financing reforms such as results-based financing and program-based budgeting under the leadership of the Ministries of Health and Finance.
- Improving data for decision making: The GFF supported implementation and tracking of the IC results framework with baseline indicators and targets. Working with the Ministry of Health, the GFF has also supported the institutionalization resource monitoring and expenditure tracking, which is used to communicate annual partner resource commitments and evaluate expenditures against these commitments.
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 Ethiopia 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 resource mapping (RM) shows trend analysis between FY 2018/19 and FY 2019/20. Resource mapping in Ethiopia is based on the Health Sector Transformation Plan (HSTP). The HSTP is the national health strategy and the investment case (IC). The consolidated data for this assessment was based on HSTP actual annual budget and annual HSTP resource mapping provided by the Ministry of Health. The RM trend analysis indicated major findings in terms of the government’s improved commitment to the health sector, which resulted in a significant decline in the HSTP financing gap. Government finance to the health sector showed a significant increase from 38.5% in 2018/19 to 53.1% in 2019/20. Accordingly, the HSTP financing gap has declined from 26% in 2018/19 to 5.7% in 2019/20. On the other hand, donor contribution both on and off budget and alignment to the IC more or less are similar in both fiscal years. In addition, community contribution entailing both societies in cash and in-kind contribution to the sector indicated similar contribution levels in both years.
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.