The GFF’s Catalytic Role
The GFF Catalytic Role provides details on the GFF support for Mozambique’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) addresses bottlenecks in service delivery, prioritizing lagging areas such as adolescent health and nutrition. By improving coordination between development partners, the IC increases effectiveness and efficiency by aligning partners around a results-focused health agenda.
- Prioritizing and implementing health financing and systems reforms: The IC seeks to maintain and increase the ratio of domestic health expenditures financing to total government expenditures. Key reforms designed to address system bottlenecks and improve the health service quality include quality-of-care scorecards and performance-based transfers to health facilities and district hospitals. The IC also focuses on scaling up the community health worker program and increasing primary health care staff to strengthen care at the community level, while also outsourcing last-mile distribution of drugs to the private sector to address shortages of essential medicines in primary health care.
- Strengthening the country platform and convening financial and technical partners at country level: In December 2020, the government chose to restructure the existing sector-wide approach, opting instead to establish a new country platform. The GFF is supporting efforts to revitalize the dialogue between the government and development partners.
- Improving data for decision making: The GFF is providing assistance to strengthen data collection for better health financing management and address weaknesses in the quality of data as revealed by the results-based program currently under way.
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 Mozambique 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 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 investment case (IC) for Mozambique has acted, since its inception in 2016, as a catalyzer for MOH and partners to advance health system strengthening efforts and alignment, breaking the traditional verticalization and fragmentation of partners’ support. In 2018, the GFF conducted a health expenditure review, showing a sustained national effort to increase funding for health (200% for the period from 2009 through 2018, corrected both in real terms and in comparison with other sectors such as internal security, peace promotion and governance). As the work on the midterm review of the IC progresses, preliminary conversations have highlighted the need to strengthen efforts in key areas, such as health financing reforms and RMET. Simultaneously, the MOH’s COVID-19 pandemic response spurred a renovated appetite to map resources being allocated to the response and to track public expenditure in health, so as to improve strategic planning, resource mobilization and allocation. Mozambique’s Minister of Health and the National GFF focal point continue to play a central role in promoting the use of RMET to conduct efficiency analysis and promote the use of data to make planning and budgeting decisions, asking partners, including the GFF, to support these efforts.
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.