The GFF’s Catalytic Role
The GFF Catalytic Role provides details on the GFF support for Nigeria’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 Nigeria aligns with the National Strategic Health Development Plan II and prioritizes: (a) increased domestic resource mobilization for the Basic Health Care Provision Fund; (b) equity, by mobilizing additional resources and using additional financing in the Nigeria State Health Investment Project to deliver high-impact maternal and child care in three fragile northeastern states; and (c) increased efficiency of the Accelerating Nutrition Results Project for the delivery of community nutrition services by nonstate actors.
- Prioritizing and implementing health financing and systems reforms: The GFF supported the operationalization of a law to deliver a basic minimum package of services and provided a US$20 million grant for a pilot in three states to demonstrate proof of concept. This resulted in bringing together donor and government resources and expanding implementation to 21 of the country’s 37 states. The GFF grant piloted the BHCPF in three Nigerian states demonstrating the transformational potential of the fund. The grant helped to unlock GoN’s commitment of the release of the 1% of the consolidated revenue fund (CRF) to the health sector in 2018. Since the implementation of the grant, the BHCPF has been implemented in the appropriation act and has now been scaled up nationally.
- Strengthening the country platform and convening financial and technical partners at country level: The GFF participates in meetings with the Development Partners Group for Health and supports increased coordination and alignment among the World Bank and other partners. In addition, GFF engagement contributed to the relaunching of a health and nutrition coordination platform. The GFF supported the RMNCAH-N coordination platform to operationalize the leadership development of the platform’s workplan with necessary measures in place to ensure good use of the knowledge acquired from the country leadership workshop. Delivery of the Country Leadership program (CLP) resulted in the RMNCAEH-N coordination platform having specific designated lead for coordination, partnership, and accountability. The training also led to improved work coordination with NPHCDA and the National Emergency Maternal and Child Health Intervention Centre (NEMCHIC); with the NPHCDA looking at ways to collaborate and avoid duplication especially in areas of Quality of Care and the Maternal deaths registry, while exploring opportunities to work together the more in the program area of family planning.
- Improving data for decision making: To assess the impact of the COVID-19 pandemic on services, the GFF supported analysis of national health information system data to identify areas of service disruption and inform health system interventions to mitigate effects on demand and delivery of essential services. In addition, the GFF provided technical support to the government of Nigeria for a COVID-19 emergency grant to develop response guidelines for including a triage and service protocol for the provision of routine health services. The findings of the study were widely disseminated to the clients at national level and in12 states where the studies were conducted through a data use workshop to enhance understanding, interpretation and subsequent use of the data for decision making.
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
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 value add of conducting Resource mapping and expenditure tracking (RMET) in Nigeria is currently being discussed with the health partners group so we can collectively engage with the government on its importance and how it complements the NHA. The initial focus following consent of the partners and the government will be on mapping and tracking donor financing, which accounts for three-quarters of domestic spending. Documenting all sources of funds is essential for the Federal Ministry of Health (FMOH) in Nigeria, not only to align and channel resources to sector priorities, but also to address issues relating to the adequacy, sustainability, efficiency, transparency, and equity of financing in the implementation of the Basic Health Care Provision Fund (BHCPF) currently being scaled up following the pilot in three states with support from the GFF. It is expected that the RMET exercise when conducted will show and guide the FMOH on how to leverage an initiative directed by the Office of the Federal Accountant General’s Consolidation Accounts Department to collect information on external financing. The target is that the RMET process will develop a systematic process for collating development assistance for health expenditure used in budgeting, resource allocation decisions, and preparing consolidated financial statements for the health sector.
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.