The GFF’s Catalytic Role
The GFF Catalytic Role provides details on the GFF support for Guatemala’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 the National Multisectoral Nutrition Strategy, La Cruzada Nacional para la Nutrición (GCNN), which sets the country’s priorities for nutrition improvement and functions as the investment case for Guatemala. Taking a holistic approach to nutrition improvement, the strategy focuses on over- and undernutrition and includes interventions in five key sectors: health, water and sanitation, social protection, social and behavior change, and agriculture.
- Prioritizing and implementing health financing and systems reforms: The GFF piloted a US$9 million performance-based buy-down, conditioned on the achievement of program results and a domestic reinvestment of US$18 million into the country’s conditional cash transfer program. The GFF provided technical assistance to program districts (7) to strengthen public financing management and improve alignment between the national health budget and annual operating plans as well as purchasing plans at departmental level.
- Strengthening the country platform and convening financial and technical partners at country level: Guatemala benefits from an extensive structure for coordination mechanisms that work both horizontally – including relevant sectors – as well as vertically – from the national to the community level.
- Improving data for decision making: The GFF is supporting the Secretariat for Food Security and Nutrition (SESAN) under which the investment case is governed, through the development of an improved monitoring and evaluation framework, including the review of indicators, data sources, baselines, and targets. The GFF is also supporting SESAN’s monitoring mechanisms through direct engagement and support to the Ministry of Social Development and the Ministry of Health, both of whom feed information into SESAN, by ensuring data and information linkages between the two ministries through the redesign and digitization of their respective information systems, to improve data capture, transformation, utilization, and interoperability.
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.
Guatemala is not dependent on external financing, with less than 2% of total financing for the health sector from external sources. The National Secretariat for Food Security and Nutrition (SESAN), which oversees the implementation of the Investment Case, finalized a costing exercise to estimate total costs of its implementation in 2021. The GFF has expressed its support towards improving the utility of the costing through a resource mapping activity that maps available resources to anticipated costs, and to further support planning, potential reprioritization and resource mobilization for any included activities demonstrated as being unfunded. Although this mapping has not been initiated, the GFF continues to engage in policy dialogue to express support for this exercise in any way requested or needed.
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.