The GFF’s Catalytic Role
The GFF Catalytic Role provides details on the GFF support for Somalia’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 Somalia prioritizes implementation of the essential package of health services (EPHS) to reduce fragmentation in health service delivery. The GFF provides technical support to help the government improve donor alignment, coordination, and enhance transparency in service delivery. The EPHS prioritizes cost-effective health interventions known to have the greatest impact upon the country’s burden of disease.
- Prioritizing and implementing health financing and systems reforms: With a focus on government stewardship, the GFF and World Bank support activities to strengthen the capacity of the Ministry of Health to carry out key public sector stewardship functions, including regulatory roles and better measuring results. It also supports capacity building for utilizing health information, including institutionalizing resource mapping and expenditure tracking to harmonize it with National Health Accounts data collection process.
- Strengthening the country platform and convening financial and technical partners at country level: The GFF provides support to the country platform (Somali Health Sector Coordination Committee), which serves as a mechanism for coordination among stakeholders including the private sector and civil society organizations. The GFF and World Bank support the Ministry of Health and state ministries to expand partnerships with nonstate actors such as nongovernmental organizations and the private sector to improve health outcomes. Going forward, the GFF and World Bank will also focus on enhancing the public sector’s ability to procure and manage these contracts.
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.
Somalia conducted resource mapping and expenditure tracking as part of its first investment case (IC) development. Prior to the exercise, little information was available on Somalia’s health sector funding – including sources (who), projects and activities (what), and geographical distribution (where) – creating fragmentation. This problem was especially acute since external health financing constitutes a large share of total health sector funding, and most is off-budget. Resource mapping helped the government develop a full understanding of Somalia’s health funding landscape to improve future planning and align the country’s IC and health strategies with available resources. The exercise mapped resources – both humanitarian and development – to Somalia’s 2nd Health Sector Strategic Plan (HSSP II) 2017–21, and essential package of health services at a subnational level.
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.
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 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.