The GFF’s Catalytic Role
The GFF Catalytic Role provides details on the GFF support for Mali’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 Mali focuses on health financing reforms and service delivery improvements through prioritized interventions, including scaling up the community health worker program, improving the supply chain for health supplies and equipment, increasing adolescent access to health services, and reducing gender-based violence. However, recent political volatility has hindered IC implementation.
- Prioritizing and implementing health financing and systems reforms: To improve financing efficiency and availability, the IC aims to increase domestic resource mobilization and roll out contracting for a package of services. The government has streamlined the process of contracting verification agents and introduced performance-based financing. In addition, technical assistance has been deployed to help defragment insurance schemes to advance universal health care. In close collaboration with the World Bank and the community health worker task force, the GFF is focusing on national-level efforts, including financing as well as scaling up the community health worker strategy, including through digital innovations.
- Strengthening the country platform and convening financial and technical partners at country level: Developed through an inclusive platform, the IC has been weakened by political unrest and the COVID-19 pandemic. Major donors and development partners are loosely aligned around the IC, with resource mapping and expenditure tracking expected to provide further useful data on budgeting and expenditure progress on the alignment agenda.
- Improving data for decision making: As part of the IC, the GFF supports improving the country’s civil registration and vital statistics system. Moreover, GFF technical assistance is helping to improve the quality, availability and use of health data. A monitoring system for the IC is also under development and the essential services monitoring under COVID-19 has been progressing well.
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 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.
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.
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 2020 Mali conducted the first round of resource mapping of its investment case (IC) for 2019 through 2023, which targets three priority areas: delivery of quality health services across the continuum of care, support to the health system pillars, and governance. The exercise tracked actual expenditures for 2018 and 2019, and also assessed budget commitments at the subnational level, for all 74 districts. As Mali joined the GFF in mid-2018, the country is currently in the initial stages of institutionalizing resource mapping, having first developed its IC. Data collection for the resource mapping and expenditure tracking exercise was completed in 2020; preliminary findings are being validated, with final results expected in fiscal year 2021. The resource mapping will be used to assess alignment with the Mali Action Plan (under development), to evaluate subnational resource allocation, and to advocate for additional financing to close the funding gap.
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.
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.