The GFF’s Catalytic Role
The GFF Catalytic Role provides details on the GFF support for Tanzania’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: With the leadership of the Government of Tanzania, the GFF provided financial and technical support for the development of the National Plan for Reproductive, Maternal, Newborn, Child and Adolescent Health and Nutrition (2021/22-2025/26) (One Plan III), in collaboration with other development partners. One Plan III has been adopted as the RMNCAH-N Investment Case, aligned to the Health Sector Strategic Plan V (2021-2026). In addition, the GFF and partners supported resource mapping and expenditure tracking (RMET) and RMET institutionalization, along with multiple advisory services and analytics.
- Prioritizing and implementing health financing and health systems reforms: The IC initially aimed to achieve efficiency gains by implementing RBF in eight regions, promoting fiscal decentralization and autonomy of health facilities. Learnings from RBF led the government to roll out the direct health facility financing in 5,807 facilities to increase spending efficiency. The GFF is supporting capacity building in health governance, focusing on public financial management. The recently concluded GFF co-financed WB Strengthening Primary Health Care for Results program - implemented in 8 of 31 regions - tied payments to outcomes, has increased access to nutrition services, and improved the delivery and quality of services in 1,734 facilities. The upcoming GFF co-financed WB project seeks to build on that agenda. It will focus on public financial management at the facility-level to improve the execution of funds transferred directly to facilities.
- Strengthening the country platform and convening financial and technical partners at country level: The GFF has contributed to the “health basket” funding and the institutionalization of mapping of resources. GFF support has ensured donor alignment and funding of indicators linked to incentives.
- Improving data for decision making: The GFF supports strengthening the quality of data and building national capacity in analytics through its collaboration with Countdown to 2030.
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 2019. 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 Tanzania 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.
In Tanzania, the RMET approach was applied in 2018 and 2019 to assess the fiscal landscape for the investment case (IC), and inform the development of the national health strategy. The report highlighted the commitment of the government of Tanzania to improved health outcomes and indicated domestic financing for the IC rose from 20% in 2018 to 39% in 2019. In addition to the increases in government spending, the report also indicated a decrease in donor contributions in relative and absolute terms and illustrated the equity and efficiency of resource allocation around RMNCAH-N priorities and provinces.
The country recently concluded a RMET exercise (after a gap of two years during the COVID-19 pandemic) in support on the newly developed RMNCAH-N strategy, One Plan III. The RMET seeks to inform priorities, identify funding gaps across programmatic areas, and improve donor alignment with national health goals. The RMET highlighted a large funding gap in FY 22 of 62%. Part of the funding gap is due to ongoing discussions with donors on their commitments.
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.