The GFF’s Catalytic Role
The GFF Catalytic Role provides details on the GFF support for Malawi’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 supported the development of the investment case (IC) for Malawi tied to the operational plan for the national Health Sector Strategic Plan 2017–22 (HSSP-II). During 2022, the GFF has supported the process and drafting of HSSP-III (2022-2030), which defines a costed essential health services package based on available resources and key national health system reforms needed. MoH has made an important step towards greater alignment by merging more than 20 existing strategies into the HSSP-III and has instructed partners to use it as their sole reference. The GFF is cofinancing a World Bank project, Investing in Early Years for Growth and Productivity, as well as the WB's COVID-19 response (EHS grant), ensuring continuation of the provision of essential health services, adapting and strengthening the front line response and infection prevention and control measures at HF.
- Prioritizing and implementing health financing and systems reforms: The main reform focuses on improving decentralized, district-level planning, budgeting, and execution, including strengthening the financial autonomy of health facilities. The GFF has given new momentum to improving district implementation plans and using them to inform national budget allocation as part of decentralizing service delivery responsibilities. The clearer identification of underfunded priorities, rolled up from subnational level, is designed to enhance donor alignment. The IC also focuses on improving the recruitment and effective deployment of community health workers and nurse-midwives, which is being operationalized by the WB COVID-19 AF Program (GFF EHS grant).
- Strengthening the country platform and convening financial and technical partners at country level: The Health Sector Working Group, chaired by the Secretary of Health, can be used as the mechanism to track and support IC implementation. The aim is to better align donors around the identified priorities and support engagement of all interested civil society organizations during IC implementation to enhance accountability. The GFF also coordinates with key partners to support the government in preparing the HSSP-III.
- Improving data for decision making: The IC supports introducing digital data collection tools, building capacity to collect and use data, and increasing coordination and interoperability across existing data systems. Other reforms include linking the civil registration and vital statistics electronic system and web-based health management information system to determine the share of registered births as well as supporting the adoption, integration, and use of birth certificates and unique ID in the provision of health services. A secondary analysis of health data was conducted to determine changes in essential health services utilization levels at the national and subnational levels during the COVID-19 pandemic.
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 Malawi 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
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.
Malawi has conducted extensive resource mapping and expenditure tracking for the health sector. More than 180 donors and implementing partners in Malawi who contribute to health financing, with external financing accounting for 75% of funding. As such, aid coordination is a key priority in improving the efficiency and effectiveness of health spending. The Ministry of Health consolidated and costed priorities from national and subnational government annual plans and strategies, then analyzed their funding sufficiency and urgency by priority and district. The resulting HSSP II Operational Plan was launched in July 2020 and illustrates the key funding gaps and opportunities for enhancing allocative efficiency and aid effectiveness. The government of Malawi will continue to update the operational tool on an annual basis, with increasing emphasis on data use and tracking implementation.
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.
Implementation Progress
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.