The GFF’s Catalytic Role
The GFF Catalytic Role provides details on the GFF support for Pakistan’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 Pakistan is led by the Federal Ministry of Health and was developed in collaboration with UNICEF and ICHESS, a contractor focused on supporting universal health care. The provincial IC Implementation plans are being developed now.
- Prioritizing and implementing health financing and systems reforms: Current costing of the IC is inconsistent with available resources. The government is seeking efficiencies in financing through the costed Essential Health Package Service, derived from the evidence-based Disease Control Priorities, or DCP3, project. Strategic purchasing of services, including quality monitoring, is under consideration, and the GFF will be working with the WB to organize a series of activities to build capacity of the provincial and federal health counterparts in health financing. Moreover, the GFF will be supporting an in-depth feasibility assessment in Sindh to collect data on quality of care, efficiency, and client preferences in order to engage the government of Sindh to develop a pilot for service delivery redesign in one district with a view to improving health outcomes for pregnant women and newborns.
- Strengthening the country platform and convening financial and technical partners at country level: The development of the IC has so far been conducted through a core committee, as the country platform is still evolving. A National Health Sector Coordination Platform is expected to convene stakeholders and coordinate universal health care efforts, including health and nutrition services for women, children, and adolescents. The GFF and partners will focus on building government stewardship capacity. The GFF and partners will support the nascent provincial UHC coordination platforms to enable the provincial departments of health to have strong monitoring and stewardship capacity of the sector
- Improving data for decision making: The GFF has provided support through the Countdown to 2030 initiative to align the national results framework with available health data sources. It will also collaborate with the Bill & Melinda Gates Foundation’s technical assistance facilities in building country and provincial platform capacity to undertake regular data reviews and remedial action plans. For the past two years, the GFF has been providing technical assistance to the government to defragment and strengthen civil registration and vital statistics systems.
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.
Pakistan’s first ever resource mapping and expenditure tracking (RMET) was completed earlier this year by Ernst and Young. The resource mapping report shows a large shortfall between the draft costed investment case (IC) and the total resource envelope at hand. The World Bank and GFF hopes to undertake another round of resource mapping and conduct the first expenditure tracking with budget and expenditures mapped against IC priorities. Moreover, with support of BMGF, the World Bank and GFF will work with the government to institutionalize RMET over the coming three to four years and promote interoperability of the IFMIS, DHIS2, and NHA.
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.