FBOs AND INNOVATING FINANCING OF UHC: GLOBAL FINANCING FACILITY IN SUPPORT OF EVERY WOMEN EVERY CHILD

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• 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 2013

• 11% of all births are to girls aged 15-19 years; complications linked to pregnancy and childbirth second most common cause of death

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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)

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2015 2030

Bill

ion

s U

S$

Resource gaps

50% of gov't health expenditure to RMNCAH

25% of gov't health expenditure to RMNCAH

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

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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

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The ultimate goal of the GFF is to drive achievement of the SDGs

Between 2015-2030, 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

GFF: Key Focus Areas

• Mobilize and channel additional international and domestic resources required to scale up and sustain efficient and equitable delivery of quality RMNCAH services.

• Support the transition to long-term sustainable domestic financing for RMNCAH.

• Special focus on the scale up of Civil Registration and Vital Statistics to contribute to universal registration of every pregnancy, every birth and every death by 2030

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Commitments to the GFF to date

NORWAY $600 million

CANADA $200 million contribution is part of Canada’s $3.5 billion commitment (2015-2020) to maternal and child health, announced in May 2014

UNITED STATES Up to $400 million in leveraged resources through financing mechanisms and public-private partnerships

IDA International Development Association Low-interest loans and grants, leveraging up to $3.2 billion

GFF Concept Note September 2014

Agenda

• A Global Financing Facility for RMNCAH

• GFF operating model

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The operational model is driven by the overall GFF approach

Smart

Scaled

Sustainable

Focus on high impact, cost-effective interventions and results

Financing RMNCAH at scale through significantly increased domestic and international financing

Support transition to long-term sustainable domestic financing for RMNCAH

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Smart: using an Investment Case approach to improve efficiency and outcomes

Govt.

Donor 1

Donor 2

Donor 3

Private sector

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

Nat

ion

al s

trat

egic

fra

mew

ork

(s)

Investm

ent C

ase

Government

Donor 1

Donor 2

GFF Trust Fund + IDA

Gavi or GFATM

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Smart: rigorous, data-driven, results-focused process to develop an Investment Case

Core analytics

Consultation

Agreement on 2030 results

(impact-level) and

main obstacles to be focused

on

Agreement by obstacle on

results (output/outcome level) and interventions

(long- and short-term)

Analysis by obstacle of demand, supply,

enabling environment, multisectoral

High-level vision Detailed diagnosis and prioritization

Investment Case

Scaled

• Achieving financing at scale is critical to reaching 2030 targets

• Four complementary approaches:

– Increasing resources from the World Bank, both through the GFF Trust Fund and IDA/IBRD

– Making more efficient use of and attracting additional donor resources at country level by strengthening planning/prioritization processes and streamlining operational modalities

– Facilitating the engagement of new partners

– Expanding domestic resource mobilization

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Scaled: GFF resources at the World Bank will come through two closely linked channels: IDA/IBRD and the GFF Trust Fund

GFF resources at the World Bank

IDA/IBRD • Primarily loans, but low income debt-distressed

countries can receive some/all in grant support • 26 of 45 GFF countries eligible for IDA will

receive >=50% of financing as grants • IDA:

• Countries with GNI per capita <$1,215 and/or lack of creditworthiness

• Longer repayment (typically grace period) and concessional terms

• ~$22.3 bn in 2014 for all sectors • IBRD:

• Countries with GNI per capita of >=$1,215 • ~$18.6 bn in 2014 for all sectors

GFF Trust Fund • Pooled resources

from multiple donors

• Grant financing that can be used flexibly

• Eligibility criteria specific to the fund

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Scaled: increasing efficiency through increased use of pooling and shared management

Donors at country level

Multi-donor trust fund at country level

Single-donor trust fund at country level

Parallel financing

Government

Globally pooled

resources from GFF TF and IDA/IBRD

Globally pooled

resources from Gavi and GFATM

Pooled resources

(with government)

Over time, increased pooling at global level

Sou

rces

of

fin

anci

ng

Over time, increased use of shared management at country level

Mech

anism

s

Scaled: engaging new partners in RMNCAH: private sector

• Attract additional resources:

– Pay-for-performance schemes: social/development impact bonds

– Co-investing/loan guarantees

– Public-private partnerships (e.g., mHealth)

• Support existing resources to operate more effectively

– Address coordination and information challenges

– Bridge funding

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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)

– Not possible to achieve 2030 goals without significant increase in domestic resource mobilization (DRM)

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2015 2030

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Sustainable: increasing domestic resources and reducing costs over time while ensuring equity

Money

Costs

Resources

- Design of benefits package - Public financial management - Strategic purchasing systems - Harnessing private-sector provision - Regulating out-of-pocket expenditures

- Strengthened general tax revenue mobilization - Increased share of general government spending - Innovative domestic financing – public and private - Development assistance for health that supports

increased domestic resource mobilization

Time

Coverage and accelerated

progress towards universal health

coverage

- Equity in all interventions - Demand-side interventions - Designing systems to address

inequities (e.g., risk pooling, geographical targeting)

Equ

ity

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Sustainable: incentives for domestic resource mobilization

• Providing TA/capacity building on public financial management

• Providing information on comparative performance and on lessons learned (including on innovative financing)

• Making the case for investing in health

• Strengthening continuity over time and accountability by ensuring involvement of civil society

• Benchmarking (publishing comparative data)

• Including indicators on progress on resource mobilization in results frameworks

• Supporting regulatory reform to “crowd in” private capital and improve access to financing for the private sector

• Using financing as an incentive (or withholding it)

• Including requirements for DRM in legally-binding agreements

• Using financing to support efforts to “de-risk” opportunities for the private sector

Formal Informal

Which Way FBOs?

Taxation

Airline

Money transfers

Sin

Philanthropy

Local

Insurance

CBHI

SHI

Business models

Social franchising

SMART FINANCING

Predictable

Efficient

Scalable

Sustainable

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