The GFF’s Catalytic Role
The GFF Catalytic Role provides details on the GFF support for Uganda’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.
- Ministry of Health and partners, with GFF support, have recently developed the successor to the Sharpened Plan which outlines the health system and health financing priorities needed to accelerate progress on health outcomes for women, children, and adolescents. This is following a joint end-line review of the first Sharpened Plan requested by the Ministry of Health and led by the Makerere School of Public Health with support from Countdown to 2030 and the GFF Trust Fund.
- The GFF is also supporting the Ministry of Health’s ongoing implementation of reforms that were important for the first Sharpened Plan and are emerging as priorities for the next five-years. This includes improving the quality and efficiency of health service delivery through results-based financing (RBF). The GFF, through the World Bank co-financed project, contributed to the scale-up and implementation of the national RBF framework for the health sector. This approach is being transitioned next fiscal year through a mainstreamed approach to strategic purchasing being supported by the Ministries of Health and Finance. Important for the next phase of this work will be the strengthening of links between strategic purchasing reforms and reforms intended to strengthen the community health platform and interventions to improve the health and human capital of adolescents in Uganda.
- These reforms to improve allocative and technical efficiency of resources in the health sector are also accompanies by a domestic resource mobilization agenda. The Ministry of Health with support from the World Bank and GFF has explored revenue generation opportunities including expanding excise taxes on alcohol and tobacco to increase domestic-public investment in the health sector. Supporting the Government of Uganda to move this agenda forward will be in an important area of value addition in the coming years.
- Finally, the GFF partnership is supporting Government of Uganda efforts to improve the generation and use of data—including through implementation research. In the first phase of support this was most visible in GFF efforts to improve birth and death registration through the Government of Uganda’s civil registration and vital statistics system (CRVS). Given the importance of data for ensuring the success of strategic purchasing reforms and the need to expand the use of data on service quality and equity, we anticipate this to be a major focus of the GFF partnership in the years ahead.
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.
Uganda’s investment case for the RMNCAH Sharpened Plan spans over the period from FY 2016/17 through 2019/20. In 2018/19, the Ministry of Health conducted a resource mapping of the IC looking at source of funding and funding gap at national and decentralized levels. Overall, the exercise shows the IC funding gap decreased over time from 46% to 29% between 2017/18 and 2019/2020, thanks to increased donor contribution: donors funded 48% of the IC cost in 2017/2018, which jumped to 65% in 2019/20. This rise was mainly driven by increased contributions from GAVI, GFTAM, and the World Bank/ GFF. Because the cost of implementing the IC increased between 2017/18 and 2019/2020, government contribution remained the same over time in relative terms, but did increase in absolute terms between 2017/18 and 2019/20. The government of Uganda is preparing its new IC and result of the previous resource mapping will help the Ministry of Health in prioritizing interventions to improve the DRM agenda in the policy dialogue with the Ministry of Finance.
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.