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

2. Global momentum to accelerate progress in RMNCAH…

3. …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)

4. 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

5. 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 , scale up in high burden countries could prevent up to:
4 million maternal deaths
101 million child deaths
21 million stillbirths

6. 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

7. 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

8. 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

9. 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)

10. 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

11. 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

12. 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

13. 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

14. 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

15. 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

16. 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

17. 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.

18. 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.

19. 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)

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