GLOBAL FINANCING FACILITY IN SUPPORT OF EVERY WOMEN EVERY CHILD Private Sector Conversation 11 March, 2015

Global momentum to accelerate progress in RMNCAH…

…but challenges remain MDG 4 and 5 unfinished agenda Large remaining funding gap - significant additional investments from both domestic and international resources needed Equitable and sustained progress under threat as countries transition from low- to middle-income status Inefficiencies in RMNCAH investments due to poor targeting and fragmented financing Poor state of civil registration and vital statistics systems (CRVS)

Increasing domestic resource mobilization is key to closing the gap in financing for RMNCAH RMNCAH financing needs in 63 low- and lower-middle-income Countdown countries Remaining gap of US$4-8 billion by 2030, depending on government prioritization of RMNCAH Peak gap of US$25-27 billion per year, of which ~US$11 billion is covered by international financing

The ultimate goal of the GFF is to drive achievement of the SDGs End preventable deaths and improve the quality of life of women, children and adolescents by significantly scaling sustainable investments in RMNCAH Between 2015-2030, scale up in high burden countries could prevent up to: 4 million maternal deaths 101 million child deaths 21 million stillbirths

Smart, scaled, and sustainable financing drives results Focus on high impact, cost-effective interventions and results Smart Results Scaled Financing RMNCAH at scale through significantly increased domestic and international financing Sustainable Support transition to long-term sustainable domestic financing for RMNCAH

Equity, gender, and rights Service delivery approaches Smart: “best buy” interventions cut across three areas: clinical/socio-behavioral, HSS, and multi-sectoral Equity, gender, and rights Mainstreamed across intervention areas Clinical and Socio-behavioral Interventions Health Systems Strengthening Multisectoral End preventable maternal and child deaths and improve the health and quality of life of women, children, and adolescents Service delivery approaches CRVS

Scaled: Achieving financing at scale is critical to reaching 2030 RMNCAH targets Approach begins with an understanding of the gap between resource needs and those available for RMNCAH The GFF works to close the funding gap by mobilizing domestic resources from both public and private sectors. Financing is mobilized from three key sources: Domestic financing (public and private); GFF Trust Fund and IDA/IBRD resources; Additional donor resources

Sustainable Basic proposition of the GFF: RMNCAH often receives a disproportionately low share of domestic resources (and does not capture appropriate share of economic growth) Achieving 2030 goals requires significant increase in domestic resource mobilization (DRM)

Achieving and measuring results Results-focused financing Different modalities to focus on supply (e.g., performance-based funding for facilities), demand (e.g., conditional cash transfers), and policy (e.g., disbursement-linked indicators) Non-RBF modalities will also be used as appropriate (e.g., input-based financing for capital investments) Measuring results CRVS: Weaknesses in CRVS have direct effects on RMNCAH Focus on registration of births, deaths, causes of death, and marriage Other forms of measurement: DHS, MICS, routine monitoring systems

A set of synergistic approaches drives smart, scaled, and sustainable financing Investment Cases Joint financing for investment cases Health financing strategies Leveraging IDA and IBRD to increase financing for RMNCAH Private sector resource mobilization

A rigorous, data-driven, results-focused process forms the basis of developing an Investment Case High-level vision Detailed diagnosis and prioritization Agreement on 2030 results (impact-level) and main obstacles to be focused on Analysis by obstacle of demand, supply, enabling environment, multisectoral Agreement by obstacle on results (output/outcome level) and interventions (long- and short-term) Investment Case Consultation Core analytics

Purpose of the Investment Case Current: gaps, overlaps, and funding of activities outside national priorities Future: Investment Case strengthens joint planning and complementary financing, resulting in more efficient use of resources and better health outcomes National strategic framework(s) Donor 3 Govt. Investment Case GFF Trust Fund + IDA Government Gavi or GFATM Donor 2 Private sector Donor 2 Donor 1 Private sector Donor 1

Developing a health financing strategy Governance, social and political change Health financing assessment Health system development Expenditure on health Total Health financing strategy Government Development Assistance for Health Implementation, including capacity building Disease burden change Economic development LIC LMIC UMIC HIC

Leveraging IDA and IBRD to increase financing for RMNCAH GFF Trust Fund designed to encourage additional allocations from IDA and IBRD by: Committing grant resources only to countries that allocate IDA/IBRD financing to RMNCAH Minimum leverage ratio generally 1:1 Adjustable volume resources allocated from the Trust Fund to countries Trust Fund resources inextricably linked to IDA/IBRD project: Complements IDA/IBRD project rather than standalone Resources can be used flexibly to provide complementary support to implementation of IDA/IBRD financing Based on the historic track record under the HRITF, the expected grant to IDA leverage is estimated to be 1:4 Ratio will differ significantly by country

Private Sector Value in Investing in Health Outcomes Private sector (for-profit actors) can complement public resource mobilization providing additional capital to expand and enhance RMNCAH efforts. Private sector partnership can take many forms. Philanthropic funding: including CSR, matched grant funding, national private sector health alliances Bridge Financing and Working Capital structure to deal with delayed or slow disbursement Private Equity and Debt Structure to support infrastructure, technology and facility upgrades Pay for Performance Structures: Social impact bonds, Development impact bonds to support longer term and diversified financing needs Public-Private Partnerships to support technology transfer, improve medical supply and pharmaceutical infrastructure as well as upgrade and management improvements

Country Level Opportunities – A Few Examples Kenya Case Study: Poor quality of care in public and private facilities (where most vulnerable go) due to poor or improper equipment. Most poor pay out of pocket and don’t have funds in emergency situations. Facility “Upgrade” solution. GFF could help decrease cost of borrowing for small facilities to help “upgrade”. Structures could include: revolving loan fund or social bond with gov’t pay-back to private sector. Financing solution. Leverage private sector remittance structures for GFF “top off” payments to ensure cash on hand in emergencies. Broader country opportunities: Need for product and business model innovations to develop low cost high quality products for the poor as well as distribution channels that reach the most vulnerable. Potential solution: Development of local private sector alliances (e.g. Nigeria Private Sector Health Alliance) to surface innovation, broker public/private partnerships, seed impact investment funds to invest in innovations.

Global and Regional Opportunities Health Bond Issued to Insurance Companies (Development Impact bond). Need to improve health surveillance systems to prevent outbreaks early and improve health systems. Potential solution: Development of a bond backed by impact driven individuals and institutional investors (like insurance companies), issued by supra-national organizations like World Bank to reduce risk or negative impact of outbreaks. The GFF could provide the performance “kicker” by providing pay out to investors or countries based on performance. Acceleration Funds. Often countries financing their own commodities do not have working capital to plan for procurements resulting in delays and limited ability to negotiate prices. Potential solution. GFF support in development of a regional or global fund to provide government with working capital and international procurement agencies to secure better prices and improve quality and timing of MNCH commodities. Global Public Goods. Support investments in global public goods that are better suited for international/global investments rather than country level, such as innovation.

COUNTRY & STAKEHOLDER CONSULTATIONS GFF timeline GFF Launch UNGA GFF Announcement Spring Meetings Washington, DC FfD Addis Ababa, Ethopia BUSINESS PLANNING OPERATIONAL PLANNING & SETUP SEP 2014 OCT 2014 DEC 2014 FEB 2015 APR 2015 MAY 2015 JUL SEP 2015 COUNTRY & STAKEHOLDER CONSULTATIONS FINANCING COMMITMENTS NGO Consultations World Health Assembly Geneva Business Plan Process supported by multi-stakeholder Oversight Group & Business Planning Team 4 Frontrunner countries (including Ethiopia)

www.worldbank.org/globalfinancingfacility GFF@worldbank.org