The GFF’s Catalytic Role
The GFF Catalytic Role provides details on the GFF support for Tajikistan’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: Based on the National Health Strategy (NHS) for the period from 2021 to 2030, the GFF will support identification of key priority actions to be implemented over the next 3 to 4 years, with a special focus on ensuring sustainable financing of the health sector.
- Prioritizing and implementing health financing and systems reforms: In collaboration with the World Bank, WHO, and five other key development partners (ADB, EU, GAVI, GFATM, IsDB), a joint statement has been developed to support health financing transition in the Republic of Tajikistan. In addition, the GFF Trust Fund is cofinancing an IDA project that supports the introduction of program-based budgeting – an essential public financial management reform – in primary health care in Tajikistan. Resource mapping and expenditure tracking (RMET) has captured information on funds available from international donors and the government, to assist in comparing available funding to the total cost of the NHS; calculating funding gaps, and identifying funding sources to fill the gap and reorient priorities for NHS implementation. The GFF is working to institutionalize the RMET within the Ministry of Health and Social Protection.
- Strengthening the country platform and convening financing and technical partners at country level: In addition to its convening role in the area of health financing, the GFF contributes to the implementation of the COVID-19 pandemic response measures, which includes supporting the COVID-19 vaccination program by facilitating interagency cooperation and ensuring the effective communication flow between key national and international stakeholders.
- Improving data for decision making: The GFF is supporting data use and analytical capacity through collaboration with Countdown to 2030 to identify key drivers of positive change and key challenges to the improvements in maternal and child health. This analytical work will also inform the development of the investment case.
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.
Tajikistan is in early stages of the investment case development, which will be formed as a short-term prioritized implementation plan for the new National Health Strategy (NHS) for 2021–30. A resource mapping exercise was conducted in 2020 and covered data from donors and development partners, public resources programmed into a medium-term expenditure framework, and a comparison of resources available with preliminary estimated cost of the NHS implementation. The mapping showed US$921 million available for health, with 68% coming from the state budget and 32% from external investments. Data from 24 donors and development partners showed a total of US$298 million investments for health planned between 2021 and 2025. The mapping of government resources shows that the total government funding from 2020 through 2022 totals US$623 million. The GFF is working with the Ministry of Health and Social Protection to institutionalize resource mapping and establish a system and process for routine data collection on health projects supported by donors and development partners. The collected data will be used for planning and management of health projects by the ministry as well as for data analysis and reporting to other government institutions.
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.