The GFF’s Catalytic Role
The GFF Catalytic Role provides details on the GFF support for Liberia’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: Across Liberia, the GFF has helped prioritize six lagging counties based on remoteness, low performance, and limited resources. Four counties received additional funding based on identified needs, while a new quality improvement bonus has incentivized results and increased funding for frontline health centers. The GFF’s resource mapping and expenditure tracking (RMET) exercise showed the investment case successfully aligned partners such as Global Fund, USAID, UNICEF, World Bank, and others around priorities.
- Prioritizing and implementing health financing and system reforms: The GFF helped build and support country capacity to conduct an electronic RMET system and health financing strategy. A GFF-supported public expenditure review found significant inefficiencies and decreases in domestic and external funding for priority counties. The RMET results, along with the review’s recommendations, are guiding reforms. The GFF is also supporting analytical work on performance-based financing (PBF) approaches implemented by partners to help create a harmonized national system. Partners have agreed to align approaches in the next funding cycle.
- Strengthening the country platform and aligning financial and technical partners at country level: The GFF has spearheaded joint donor missions with the World Bank, GAVI, Global Fund, and USAID, which resulted in agreement on specific actions with the Liberia Ministry of Health (MOH). The GFF is also supporting the Health Sector Coordination Committee, chaired by the MOH, and promoting inclusion of nongovernmental and civil society organizations, along with country representatives. A 2020 country platform assessment (CPA) showed improved coordination and collaboration, including within joint missions.
- Improving data for decision making: The CPA also demonstrated that GFF support for verification of PBF data by health facilities, use and dissemination of performance evaluation review and RMET data, and scorecard data visualizations have led to routine data quality improvements (for instance, the error rate fell from 45 percent in Q4 of 2018 to 11 percent in Q3 of 2020). The GFF has also helped expand civil registration and vital statistics systems in 65 percent of hospitals, 17 percent of health centers and 29 percent of health districts. Maternal and neonatal deaths are now reviewed weekly at the central level by a newly established technical committee supported by the GFF.
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.
The resource mapping shown in the graphic is sourced from the government of Liberia’s online national resource mapping system (ZOHO). As of October 2021, the government and donors listed below collectively contribute US$151 million to the investment case (IC). Domestic government resources account for approximately 47% of total resources available. The government of Liberia is committed to funding the IC through increased resource mobilization and demonstrates their commitment through updating, analyzing, and making informed decisions based on resource mapping data.
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.
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-19 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.