The GFF’s Catalytic Role
The GFF Catalytic Role provides details on the GFF support for Niger’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 of a costed and prioritized investment case: The investment case (IC) under development for Niger builds on the existing national health platform and prioritizes, among other interventions, sexual and reproductive health and rights (SRHR) as well as stunting.
- Prioritizing and implementing health financing and systems reforms: Niger is among the “accelerator countries” for sustainable health financing within the Global Action Plan. As such, the IC prioritizes health financing reforms, such as strategic purchasing and efficiency reforms. As part of the national universal health coverage strategy, the GFF supports a new results-based financing scheme to strengthen the free health service policy for women and children under five years old and improve adolescent access to quality services. To inform reforms, the GFF is supporting assessments on fiscal space, equity, and financial protection as well as efficiency of public finance management. The GFF supports policy dialogue via World Bank instruments on gender equality and increasing adolescents’ access to SRHR services, among others.
- Strengthening the country platform and convening financial and technical partners at country level: The GFF is working to align multiple donors around key priorities and a technical working group representing all stakeholders meets twice a month to finalize the IC, which will implement through the existing national health platform. The resource mapping and expenditure tracking exercise helped establish a collaboration with the World Health Organization to jointly track COVID-19 resources. The GFF is also collaborating closely with the World Bank, Global Fund, and UNICEF to support the operationalization of the community health worker strategy.
- Improving data for decision making: The GFF is promoting greater coordination among partners to support better data and monitoring via geospatial mapping, strengthening of the web-based health data management system, and other tools. As part of the IC process, data quality assessments and development of the IC results framework are currently under way, in collaboration with the technical working group and partners. The Countdown to 2030 initiative has helped strengthened GFF collaboration on RMNCAH-N with the National Institute of Statistics.
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.
The resource mapping and expenditure tracking (RMET) exercise in Niger focused on the Health Development Plan (PDS) and showed the importance of external resources COVID-19 response plan (67% of the resources committed for the financing of the PDS in 2020 come from external financing, with 91% for the COVID-19 response plan). The exercise also showed a relatively large share of resources going through the state budget (64%), and a significant financing deficit for the health care services program, despite the fact that it alone accounts for more than 45% of the total funding allocated to the PDS. Lack of efficiency in the allocation of resources, with some overfunded subprograms (capacity building, availability of health products, nutrition) and some largely underfunded (protection mechanisms of financial risk, communicable diseases). Inequity in the allocation of resources at the regional level was also seen (for example, low level of resource allocation per capita in the Maradi region, which has one of the highest infant and child mortality rates). The upcoming RMET exercise must integrate information needs into the government budgeting tools and enable a greater predictability of partners’ financial commitments.
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.