The GFF’s Catalytic Role
The GFF Catalytic Role provides details on the GFF support for Zambia’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 costed and prioritized investment case: With strong leadership from the government and support from the GFF, Zambia has been developing an investment case (IC) since December 2019. The IC will be a subset of a national roadmap, aligned with the upcoming five-year National Health Strategy Plan (2022–26). The COVID-19 pandemic has delayed completion of the IC, now expected in late 2021.
- Prioritizing and implementing health financing and systems reforms: During IC development, focus has shifted to the broader objective of strengthening systems. Due to substantial fiscal constraints, health financing reforms — especially efficiency improvements — are still in initial stages.
- Strengthening the country platform and convening financial and technical partners at country level: The IC is being developed by an existing national steering committee, recently expanded to include all stakeholders. The GFF provided technical assistance to the Ministry of Health (MOH) to support this ongoing evolution, including revising terms of reference and engaging with private sector partners. Besides the MOH and GFF, several cooperating partners, including the Swedish International Development Cooperation Agency, World Health Organization, and UNFPA, have supported the process by filling gaps to help overcome delays related to COVID-19. UNICEF contributed technical support in using the EQUIST data tool to help identify key bottlenecks and priorities.
- Improving data for decision making: Improving the use of data, particularly at the subnational level, will serve as a main objective of the IC currently under development. Specific priorities and areas of investment have yet to be determined.
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.
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.
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.
As part of the aid coordination mechanisms, Zambia has routinely mapped donor activities and financing in the health sector since the 1990s. The depicted figure shows the estimated funding in the health sector in Zambia in fiscal year 2019.
The GFF is supporting a detailed resource mapping exercise to assess the overall, and area specific funding gaps. This exercise will assess funding sufficiency for RMNCAH+N activities as outlined in the Investment Case. It will also highlight the overall health-sector funding gap, and map available resources against the new National Health Strategic Plan's key priority areas. Finally, the resource mapping and National Health Accounts are being supported and undertaken as part of the same process to enhance the relevance of findings for decision-making.
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.