The GFF’s Catalytic Role
The GFF Catalytic Role provides details on the GFF support for Rwanda’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 GFF supports the development of the costed National Early Childhood Development Program Strategic Plan (NECDP SP) 2018–24 and subsequently National Child Development Agency Operational Plan 2022-2024, which serves as the investment case (IC) for Rwanda. Priorities include a community-based behavioral change programs, the roll out of innovative approaches for growth monitoring, the scale-up of the home-based early childhood development and reforming of the community health worker program through improved performance management and incentives system.
- Prioritizing and implementing health financing and systems reforms: The GFF supports strengthening public financial management through a comprehensive multisectoral nutrition budget tracking and evaluation system to ensure resources are efficiently used and directed toward the most vulnerable groups. The GFF also supports reforms in improving financial sustainability and operational management of community-based health insurance that contributes to improving financial protection for the poorest. The GFF has supported the rollout and expansion of the nutrition sensitive direct support cash transfer program and supports the interoperability of information systems to effectively administer the program, focusing on better targeting and digital payment systems.
- Improving data for decision making: The GFF supports focus on establishing a performance monitoring dashboard to track the convergence program, strengthening the interoperability across sectoral data systems (health management information system, social protection, national identification) and enhance capacity regarding data analytics. The GFF supports the government in scaling up various accountability tools (including scorecards for child health, development, and nutrition) to enhance the implementation of priority programs at district level. Furthermore, the GFF promotes the use of data for decision making within the country platform and subnational governments. In addition, the GFF has contributed to the regulatory reforms to improve registration of birth and deaths at the health facility level and link the national civil registration and vital statistics system to the safety net programs to enable better enrollment and compliance monitoring.
Note:NECDP changed to NCDA (National Child Development Agency) in December 2020
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 Rwanda 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 Ministry of Health has detailed information on external resources through the government’s health resource tracking tool. However, since Rwanda’s investment case focuses primarily on nutrition, multisectoral resource mapping is needed. The GFF supports the Nutrition Expenditure and Institutional Review (NEIR) that provides detailed analysis of the level and composition of government and donor spending on multisectoral nutrition program using the National Early Childhood Development Program Strategic Plan (which serves as the GFF investment case for Rwanda) as reference. Moreover, the review identified critical institutional and public financial management arrangements critical to enhance budget oversight and accountability for results. NEIR provides groundwork for policy dialogue with the government on institutionalizing multisectoral expenditure tracking system. The GFF supports ongoing technical assistance in fiscal year 2021 to support government achieving such objectives through a series of policy reforms under the Human Capital for Inclusive Growth Development Policy Financing, More specifically the GFF supports the institutionalization of nutrition budget tagging and tracking through IFMIS and regular performance review.
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.
GFF Rwanda Country Engagement Framework
The Country Engagement Framework highlights reforms prioritized by the country, and links them to output and outcome indicators which represent the measurable results that the reforms intend to help achieve. By selecting a specific reform within the drop down menu, the user can see the intended results that correspond with that reform as represented by specific output and outcome indicators. Where implementation progress is mature and data are available for output and outcome indicators, users can click on the arrow to access results in data section below.
Implementation Progress Data
The data in this section is aligned with the Rwanda Theory of Change and data 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.