GLOBAL FINANCING FACILITY IN SUPPORT OF EVERY WOMEN EVERY CHILD

2 Agenda The Need and the Vision What: Smart, Scaled, and Sustainable Financing for Results How: Key Approaches to Deliver Results Who: The Country Platform The GFF Trust Fund Governance Timeline

3 Agenda The Need and the Vision What: Smart, Scaled, and Sustainable Financing for Results How: Key Approaches to Deliver Results Who: The Country Platform The GFF Trust Fund Governance Timeline

Reduction in <5 mortality rate: from 90 deaths per 1,000 live births in 1990 to 46 in 2013 (40% are newborns) Reduction in MMR: from 380 deaths per 100,000 live births in 1990 to 210 deaths in % of all births are to girls aged years; complications linked to pregnancy and childbirth second most common cause of death 4 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) 5

Peak gap of US$25-27 billion per year, of which ~US$11 billion is covered by international financing Remaining gap of US$4-8 billion by 2030, depending on government prioritization of RMNCAH Increasing domestic resource mobilization is key to closing the gap in financing for RMNCAH 6 RMNCAH financing needs in 63 low- and lower-middle-income Countdown countries

The GFF is part of a broader global effort Financing for Development agenda Development of the Sustainable Development Goals, with the unfinished business of MDG‘s 4 and 5 being a key priority Dialogue amongst global financing institutions about graduation and financial sustainability in the development continuum Renewal of the Every Woman Every Child Strategy 7

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

9 Agenda The Need and the Vision What: Smart, Scaled, and Sustainable Financing for Results How: Key Approaches to Deliver Results Who: The Country Platform The GFF Trust Fund Governance Timeline

10 What: Smart, scaled, and sustainable financing for results Smart Scaled Sustainable Focus on evidence-based, high impact interventions and results Maintain RMNCAH results through domestic financing Finance RMNCAH at scale through significantly increased domestic and international financing Results

11 Smart: “best buy” interventions cut across sectors Clinical service delivery and preventive interventions Health systems strengthening Multisectoral approaches End preventable maternal and child deaths and improve the health and quality of life of women, children, and adolescents Service delivery approaches CRVS Equity, gender, and rights Mainstreamed across areas Prioritizes interventions with a strong evidence base demonstrating impact Further focuses on improved service delivery to ensure an efficient national response, such as through: Task-shifting Integration of service delivery Community health workers Range of factors influencing private sector service delivery

12 Scaled: Achieving financing at scale is critical to reaching 2030 RMNCAH targets Peak gap of US$25-27 billion per year, of which ~US$11 billion is covered by international financing Remaining gap of US$4-8 billion by 2030, depending on government prioritization of RMNCAH 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

13 Sustainable: Ensuring sustainable provision of scaled-up RMNCAH results UMIC HIC Government Disease burden change Economic development Development assistance for health LMICLIC Expenditure on health Health system development Total Governance, social and political change To promote sustainability the GFF supports countries around all three health financing functions: Domestic resource mobilization Risk pooling Purchasing

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 (e.g., DHIS2) 14

15 Agenda The Need and the Vision What: Smart, Scaled, and Sustainable Financing for Results How: Key Approaches to Deliver Results Who: The Country Platform The GFF Trust Fund Governance Timeline

How: A set of synergistic approaches drives smart, scaled, and sustainable financing 1.Investment Cases 2.Complementary financing of the Investment Case 3.Leveraging IDA and IBRD to increase financing for RMNCAH 4.Health financing strategies 5.Crowding-in private sector engagement 6.Global public goods 16

17 1. The Investment Case Core analytics Consultation Agreement on 2030 results (impact- level) and main obstacles to be focused on Agreement by obstacle on results (output/outco me level) and interventions (long- and short-term) Analysis by obstacle of demand, supply, enabling environment, multisectoral High-level visionDetailed diagnosis and prioritization Investment Case

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

3. Leveraging IDA and IBRD to increase financing for RMNCAH GFF Trust Fund designed to encourage additional allocations from IDA and IBRD by: 1.Committing grant resources only to countries that allocate IDA/IBRD financing to RMNCAH 2.Adjustable volume resources allocated from the Trust Fund to countries 3.Trust Fund resources inextricably linked to IDA/IBRD project: Complements IDA/IBRD project rather than standalone 4.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 19

20 4. Health financing strategies Sustainable provision of scaled-up RMNCAH results Implementation, including capacity building Health financing assessment Health financing strategy Comprehensive assessment: Entire health sector, not only RMNCAH Both public and private Historical trends and forward-looking projections Efficiency and equity Costed implementation plans to facilitate implementation: Based on national planning cycles and ideally in tandem with Investment Case (3-5 years) Includes capacity building and institution strengthening Long-term vision for sustainability of financing for 2030 targets: Domestic resource mobilization Risk pooling Purchasing

5. Crowding-in private sector engagement There is significant untapped potential in the private sector at the national level, including around: – Service delivery – Supply chain management – Medical technology – Access to finance Key entry points: Investment Cases and health financing strategies, both of which take mixed health systems approach Possible complementary global approaches to mobilize resources from the private sector: – Health bond – Special topic commitments 21

6. Global Public Goods Definition: non-excludable, non-rivalrous, benefiting multiple countries Initial phase: – Build on existing HRITF experience with evaluation and knowledge management – CRVS “Center of Excellence” Subsequent phase: specific initiatives to be defined within these broad categories: – Knowledge, learning, and evaluation – Data and information systems – Commodities – Innovation 22

23 Agenda The Need and the Vision What: Smart, Scaled, and Sustainable Financing for Results How: Key Approaches to Deliver Results Who: The Country Platform The GFF Trust Fund Governance Timeline

24 Who: the country platform Preparation and endorsement of Investment Case and health financing strategies Complementary financing Coordination of technical assistance and implementation support Coordination of monitoring and evaluation Not prescriptive about form (building on lessons from IHP+, Global Fund, Gavi) Build on existing structures while ensuring that these embody two key principles: inclusiveness and transparency Diversity in frontrunner countries: Ethiopia and Tanzania used existing structures Kenya established a new national steering committee Government Civil society (not- for-profit) Private sector Affected populations Multilateral and bilateral agencies Technical agencies (H4+ and others) StructuresPartnersRoles

25 Agenda The Need and the Vision What: Smart, Scaled, and Sustainable Financing for Results How: Key Approaches to Deliver Results Who: The Country Platform The GFF Trust Fund Governance Timeline

GFF Trust Fund Eligibility – 63 low and lower-middle income countries – Must be willing to commit to increasing domestic resource mobilization and to using IDA/IBRD for RMNCAH Roll-out – Four frontrunner countries (DRC, Ethiopia, Kenya, Tanzania) – Additional countries to be selected between April and June 2015, fully apportioning existing resources Resource allocation – Three criteria: need, population, income – Methodology for combining based on IDA formula – Floor of US$10 million; ceiling of US$50 million – No repartition by issues/target population – CRVS fully integrated but additional funding of up to US$10 million if country includes in Investment Case and uses IDA/IBRD Operational approach – Fully integrated with IDA/IBRD, as in HRITF 26

27 Agenda The Need and the Vision What: Smart, Scaled, and Sustainable Financing for Results How: Key Approaches to Deliver Results Who: The Country Platform The GFF Trust Fund Governance Timeline

28 GFF governance at the global level should be designed to support two key functions Function 1: Ensure GFF as a financing partnership succeeds in mobilizing and co-financing high-quality RMNCAH investment cases in GFF countries by Driving partner agreement on effective strategies/policies to support aligned financing and efficient resource allocation in/across GFF countries Monitoring performance of the GFF as a partnership, and ensuring accountability for aligned financing and for achievement of RMNCAH results in focus countries Mobilizing domestic and international (including private) resources for financing of RMNCAH investment cases at country level Driving learning and innovation around effective/efficient financing approaches Building high-level support for the GFF Function 2: Ensure the GFF Trust Fund provides financing for RMNCAH investment cases that is aligned and drives innovation, sustainability and results Set strategic funding approach and priorities for financing from GFF TF, including innovative use of TF resources to maximize mobilization of IDA and domestic resources Approve GFF funding allocation Agree annual work plan and budget of the TF Secretariat Oversee TF and Secretariat performance to ensure investments deliver results

29 Integrated governance of GFF as a financing facility and of the GFF TF Investment Case GFF Investors Group Trust Fund Committee GFF Trust Fund UNSG High Level Champions Group GFF Secre- tariat PMNCH World Bank Board Structurally linked governance of GFF financing facility and of GFF TF GFF Investors Group leads governance of multi-stakeholder financing partnership to ensure effective co- financing of RMNCAH investment cases in GFF countries (Function 1) GFF TF Committee: subset of the Council (TF donors) with devolved decision-making on GFF TF allocations (Function 2) GFF Secretariat manages TF and provides support to Council and TF committee WB Board: final commitment of TF and IDA resources; fiduciary oversight PMNCH leads global advocacy and accountability on Global Strategy/EWEC; conducts broader stakeholder engagement around GFF UNSG Champions Group would include GFF as a key financing platform for Global Strategy Quality assured, nationally- owned, multi-stakeholder process following IHP+ principles aligned co-investments +IDA Basic structure agreed upon; discussions ongoing on interfaces between structures

30 Composition and working mode of GFF Investors Group Membership in the Investors Group is based on active contribution to the success of the GFF and promotes the engagement of stakeholders who make substantial financial or in- kind assistance to Investment Cases and health financing strategies: Participating countries (ministries of health & finance)4 – 6 members Bilateral donors contributing to the GFF4 – 6 members H4+ partners3 members World Bank1 member Gavi and Global Fund to Fight AIDS, Tuberculosis and Malaria2 members Non-governmental organizations (one each from developing and developed countries) 2 members Private sector (including private foundations)2 members PMNCH1 member There will be some flexibility to include new donors to the Investors Group; however, to remain nimble, a sharing of seat or rotation system may be introduced.

31 Agenda The Need and the Vision What: Smart, Scaled, and Sustainable Financing for Results How: Key Approaches to Deliver Results Who: The Country Platform The GFF Trust Fund Governance Timeline

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