en Year joined GFF
2017
Investment Case timeframe
2017-2021
World Bank co-financed project effective
2018
World Bank co-financed project effective
2019

The GFF’s Catalytic Role

The GFF Catalytic Role provides details on the GFF support for Haiti’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 Haiti, which is under development, has created momentum for streamlining links between existing strategies, such as the 2021-31 Health Sector Plan, and setting priorities around which the many partners in Haiti could align. Despite delays due to the COVID-19 pandemic and significant political unrest, the country, with support from key partners, continues to advance on important reforms in community health, supply chains, information systems, and surveillance.
  • Prioritizing and implementing health financing and systems reforms: The IC focuses on moving resources to the front lines for increased efficiency and enhancing preventive care through community service delivery. To better balance the geographic deployment of human resources, the government launched a standardized national community health workers strategy. Other priority reform areas include scaling up results-based financing for primary health care services with World Bank and GFF support, creating a sustainable medical storage and distribution mechanism to strengthen the supply chain, and enhancing surveillance and laboratory capacity.
  • Strengthening the country platform and convening financial and technical partners at country level: The GFF is acting as a catalyst for leveraging partnerships within the Ministry of Health and with other government and nongovernment entities to achieve outcomes and priorities outlined in the IC and increase donor alignment. Recently, the Global Fund entered a cofinancing agreement with the World Bank and GFF for health systems reforms. The GFF and partners are supporting the restructuring of the project implementation unit and cooperating to scale up performance-based financing.
  • Improvement of data for decision making: To support data-informed decision making, the government of Haiti continues to strengthen epidemiological surveillance and monitoring and evaluation mechanisms, building on significant improvements in health management information systems. In addition, parallel efforts are under way to improve the interoperability of other data systems used for the country’s supply chain, human resources, community health, and laboratories.
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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 RMNCAH-N IMPACT INDICATORS
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Note: The estimated stillbirth rate reported by the UN Inter-Agency Group for Child Mortality Estimation for Haiti is 20.5 for the year 2016 and 21.5 for the year 2012 (per 1,000 total births)

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.

CORE HEALTH FINANCING INDICATORS
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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. 

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Population-Based Survey Coverage Indicators
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Resource Mapping

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.

In July 2019, the External Cooperation division within the planning unit of Haiti’s Ministry of Public Health and Population launched a resource mapping of funding — both national budget and external financing — in the health sector. Among the objectives of this resource mapping exercise is an assessment of how available financing maps to budgetary requirements outlined in sectoral strategies and plans. These strategies and plans include the country-led investment case under development, key reforms in the health sector, and geographic distribution of funds. Haiti initially planned to complete its resource mapping by May 2020. However, the COVID-19 outbreak interrupted the resource mapping exercise in January 2020. The resource mapping exercise will be undertaken as part of the investment case development process, once priorities have been defined.

 

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Resource Mapping
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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.

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Monitoring The Country-led Process
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Monitoring of Essential Health Services

The GFF supports routine monitoring of disruptions to essential health services. The essential health services data included in the graph below are sourced from country routine health information systems and shown monthly starting at the beginning of 2020. The analysis compared the observed service volume to what would have been expected had the pandemic not occurred, and reports the difference as a percentage. Positive values indicate a surplus of services, 0 indicates the expected level of services, and negative values indicate a lower volume than expected based on pre-pandemic values. In some countries, these changes in volume could be due to non-COVID reasons.

The number of monthly deaths from Covid-19 is reported as a measure of the pandemic’s reach. The data on deaths from the Covid-19 pandemic were sourced from Johns Hopkins University (JHU) dashboards and compiled into monthly aggregates. The data used in this report were sourced 8/24/2021.

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