The GFF’s Catalytic Role
The GFF Catalytic Role provides details on the GFF support for Senegal’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 Senegal prioritizes providing of a high-impact health and nutrition package, enhancing adolescent health through multisector approaches, increasing health services supply by strengthening human resources, and strengthening health system governance. The IC also addresses equity by focusing on the regions with lagging health outcomes and socioeconomic indicators. The IC came to an end last June and discussions are underway with the MOH to evaluate its implementation.
- Prioritizing and implementing of health financing and systems reforms: The GFF supports development of harmonized fiduciary procedures to help the government manage funding and strengthen internal audits, as well as training accountants to implement program-based budgeting. The IC aims to increase the domestic budget for health and integrates free health care into an insurance scheme. By expanding demand-side financing mechanisms in prioritized regions, the IC seeks to improve financial access to services and support universal health care. The GFF also supports strengthening human resources in remote areas, introducing cash transfers to empower women and girls, and strengthening the supply chain by contracting private operators for last mile drug and equipment supply.
- Strengthening the country platform and convening financial and technical partners at country level: The GFF platform is the first health coordination mechanism in Senegal. It draws attention to government priorities and supports partner alignment, enabling civil society participation in the implementation and monitoring of the IC. The GFF supports the government in overseeing health financing reforms, aligning partners around health financing for UHC and facilitating knowledge creation and information sharing. The GFF also supports the Alignment Agenda through the institutionalization of the RMET and its harmonization with NHAs, as well as reforms to prioritize primary health care financing.
- Improving data for decision making: The GFF supports stronger data monitoring of IC implementation. Data analysis have helped monitor essential health services delivery and utilization during the COVID-19 pandemic. A committee that include monitoring and evaluation officers from the units implementing the IC is in charge of collecting and validating data.
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 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.
Senegal completed its resource mapping and expenditure tracking (RMET) in June 2021. The analysis shows that the resources allocated to investment case (IC) priorities amount to US$814 million for the period 2019 to 2022. Technical and financial partners are strongly aligned to the IC, contributing nearly half (49%) of the total resources, while government contribution remains modest (30%). The World Bank (27.5%), USAID (19.3%), Gavi (13.0%), AFD (12.3%), and the Global Fund (10.4%) represent the top five donors. Combined, these account for approximately 82.5% of total donor funding for the period from 2019 to 2022, with no funding gap. Expenditure tracking indicates that the overall execution rate of the year 2020 resources is above 80%.
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.
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.