The GFF’s Catalytic Role
The GFF Catalytic Role provides details on the GFF support for Zimbabwe’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) under development for Zimbabwe focuses on the broader health sector, including women, children, and adolescent health and nutrition. The IC priorities are included in the National Health Strategy (2021–25) and partly financed by a US$25 million GFF grant. The One Health tool and the World Bank-developed Health Interventions Prioritization Tool (HIP tool) were used to identify key priorities, increasing focus on results, efficiency, and partner alignment.
- Prioritizing and implementing health financing and systems reforms: World Bank additional financing for the Health Sector Development Support Project was approved in December 2020. The financing includes US$20 million to support the IC, specifically for results-based financing (RBF) implementation in 18 districts, expansion of the urban voucher program for the poor, expansion of quality in hospitals, and enhancing governance and health financing reforms. It also includes dedicated funding for the COVID-19 response, enabling the government to fund part of its national response plan.
- Strengthening the country platform and convening financial and technical partners at country level: As a result of the GFF-supported country platform assessment, the government chose the Health Sector Coordination Framework as the new country platform. The new platform will need to be strengthened to perform as a key tool for donor coordination and alignment, using data for strategic decision making and course correction.
- Improving data for decision making: Zimbabwe has a strong and functional health management information system with well-designed risk-based verification for RBF and a rich culture of data collection. GFF support has focused on assessing the disruption to basic essential services caused by COVID-19, supporting a feasibility assessment for using block chain technology in commodity tracking and RBF verification, and studying the use of machine learning for early warning of service disruption and RBF institutionalization.
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.
The Ministry of Health and Child Care (MOHCC) has been conducting annual resource mapping and expenditure tracking since 2015. This exercise collects budget and expenditure data for domestic and external sources of funding within the health sector. The data have been used to inform planning and coordination of resources in the health sector (for example, Global Fund grant applications), to identify and address inefficiencies in the health sector, and to inform the costing and gap analysis of national strategic plans, in particular the National Health Strategy (2016–20). Zimbabwe is in the process of developing a health sector investment case through 2025, which will be finalized once the National Health Strategy (2021–25) is in place, to ensure alignment between the two documents.
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.