GLOBAL FINANCING FACILITY (GFF) COUNTRY CONSULTATIONS FACT

SHEET: Lessons Learned from GFF Front Runner Countries – Kenya and
Tanzania

1. What is the Global Financing Facility (GFF)?

The Global Financing Facility (GFF) for Reproductive, Maternal, Newborn, Child and
Adolescent Health (RMNCAH) was announced at the UN General Assembly in September
2014 by the World Bank Group and governments of Canada, Norway, and the United States.
In July 2015, additional donors were announced, including the Government of Japan and the
Bill & Melinda Gates Foundation. In support of Every Woman Every Child (EWEC) initiative,
the GFF seeks to mobilize support for developing countries to end preventable maternal,
newborn, and child deaths by 2030, and finance Sustainable Development Goal (SDG) 3
“Healthy lives.”

In driving achievement of SDG3 related to RMNCAH, the GFF seeks to end preventable
deaths and improve the quality of life of women, children and adolescents by significantly
scaling up sustainable investments. It envisions that between 2015 - 2030, scale up in high
burden countries could prevent up to: 4 million maternal deaths; 107 million child deaths,
and 22 million stillbirths. The GFF plans to achieve its vision through scaled, smart and
sustainable financing approaches at the country level.

Led by the World Bank, the development of the GFF is being developed in coordination with
many stakeholders including national and donor governments, UN agencies, and civil society
organizations (CSOs) at the global and national level. A GFF Business Plan sets out the
modality and structure of the GFF, while country investment frameworks will outline
implementation plans. The approach as outlined in the initial GFF concept note explicitly
includes feedback from the RMNCAH community and civil society in each GFF country during
the consultative period. The GFF in-country approach to date has included two main
elements: 1) a country-level consultation with government, 2) development of a country
investment framework.

Since January 2015, GFF country consultations have taken place in four front runner
countries: Kenya, Tanzania, Ethiopia and the DRC. The GFF country consultation recognized
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national RMNCAH civil society organizations should be given an opportunity to provide input.
It is important to note that the GFF country consultation was undertaken at a fast pace,
with little information provided to CSOs on the process itself. Specifically in Tanzania, it has
been challenging for advocates to engage in the development of the investment framework.
In August 2015, the four front runner countries were in the final stages of developing
country investment frameworks.

The expansion of the GFF to eight additional countries — Bangladesh, Cameroon, India,
Liberia, Mozambique, Nigeria, Senegal and Uganda — will require country consultations, and
the development of country investment frameworks. It is critical that CSOs in these
countries engage in the GFF country process to: 1) ensure the participation of CSOs and
accountability in the GFF; 2) advocate for the inclusion of reproductive health in the
development of the investment frameworks.

This briefing paper aims to share lessons learned for national advocates during the GFF
country-level process in Kenya and Tanzania. It aims to increase the knowledge and
awareness of national advocates on key policy issues, and identifies service gaps advocates
may want to address in GFF investment frameworks.

2. What does the GFF in-country approach entail?

The GFF in-country approach to date has included two main elements: 1) a country-level
consultation with government 2) development of a country investment framework. The
approach focuses on the development of country-level targets to be achieved by 2030 and,
what is required to get there from a 2015 country baseline based on existing national
planning processes.

The GFF assumes mobilization of domestic resources as economies grow and countries rely
less on grant financing from external sources and shift to concessional and commercial
loans. However, we as RH advocates, encourage governments to increase state capacity to
collect taxes, as well as good governance to ensure resources are provided to public
services including reproductive health. We are concerned that domestic mobilization simply
through loan funding is not sustainable.

The GFF assumes countries will include the following in their investment frameworks:

• Full estimates of the costs of delivering “best-buy” RMNCAH interventions (health/other

sectors) at scale;

• Full financing drawing from domestic (public/private) and international resources. It is

important to note the emphasis is on increasing domestic financing through linking of
grant to loan funding;

• Results-focused delivery to encourage innovation and maximize value-for money;

• Sustainable financing aligned with national health-sector strategies and public-sector

budget processes looking at Overseas Development Aid as an “additional”.

The key drivers of the GFF process are the country investment frameworks: 3 – 5 year
plans that include national, evidence-based and high impact interventions, and a rigorous
country assessment of RMNCAH needs and priorities. It is important to note that only ‘best
buy’ interventions - that include clinical, health systems strengthening, and multi-sectoral

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approach that multiple financiers can support - will be prioritized in the country investment
framework. This means a country’s national financing strategy will employ a health-sector-
wide approach that runs up to 2030. Long-term financial sustainability (public and private)
will be key to supporting the operationalization of the framework. Key activities by countries
include creation of a financing assessment, domestic resource mobilization strategy, plus
policy, public finance and administration reforms.

We, as RH advocates, are concerned that the GFF financing modalities must be rights-based
and equitable, ensuring that additional funding is delivered to the full range of RH services
and commodities needed to achieve the SDGs. There must be commitment to respecting,
protecting and promoting the right to health in both GFF governance and investment plans.
One key concern is how the GFF will increase overall funding availability for integrated
RMNCAH services at scale in countries that are currently almost entirely donor dependent.

CSOs have a critical role to play in informing the priorities set in the national investment
framework, calling for the inclusion of certain core principles, and ensuring accountability.
As investment cases become operational, CSOs are also essential to seeing that the GFF
fulfills its potential for improving the health and wellbeing of women and children.

3. CSO involvement in Kenya and Tanzania

To date, there has been no standardized process for engagement with CSOs in the GFF
country approach, and engagement at the national level has varied considerably. For
example, in some countries, CSOs are not even aware of the process or have no means of
engaging. In Kenya and Tanzania, CSO engagement has not taken a standardized
approach.

In Kenya, the Advance Family Planning (AFP) initiative East Africa Regional Advisor took
advantage of the early GFF process exposure and mobilized CSOs for strategic and timely
advocacy from December 2014, only two months after the initial GFF announcement in
November 2014. CSOs began to strategize at the national level, as well as through
connecting with international partners and consultations. The International Planned
Parenthood Federation (IPPF), Reproductive Health Supplies Coalition (RHSC) Secretariat
and AFP initiative were critical in mobilizing the RH movement including global and national
advocates. Support was provided to AFP’s East Africa Regional Advisor and Kenya and
Tanzania AFP program team leads at Jhpiego and JHUCCP to engage with the GFF country-
level process through technical briefings, sharing intelligence, and continued mentorship to
other CSOs. The RHSC Advocacy and Accountability Working Group biweekly
teleconferences became an invaluable forum for CSO coordination on all items related to the
GFF.

The Kenya Health NGO Network (HENNET), the Kenya Red Cross, together with the CSO
coordinating appointee of the Kenya World Bank office, worked with the AFP staff team in
Jhpiego Kenya to mobilize CSO advocates for the initial GFF consultation event that took
place in January 2015. With technical briefs from IPPF and RHSC, CSO positioning for the
GFF advocacy agenda was well informed. Excellent engagements set the tone loud and
strategic enough that has continued to inform the reported success to date – detailed tips
on the process “dos and don’ts” outlined in lessons learned section below.

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In Tanzania CSOs did not have the opportunity to get organized as the process of
developing a national investment framework was not clear and not shared with CSOs.
Without CSO involvement, GFF teams directly engaged donors and government in March
2015. The AFP country program officer mobilized CSOs to work together, sharing lessons
and intelligence on national processes, and voicing their concern and ensuring their
engagement thereafter.

At the global level, the RHSC bi-weekly GFF Workstream teleconferences were invaluable for
international and national partners to share progress, intelligence and strategize on joint
action. At the national level, it proved critical to coordinate with likeminded CSOs to
overcome barriers. However, it is worth mentioning the following challenges:

 Be prepared for a rapid response. CSOs engaging in the GFF country approach
had to adapt to the rapid pace of the process. Often the process was not
transparent, and the time scales were tight, with a lack of clarity regarding the key
focal points to follow up at the Ministry of Health, Ministry of Finance and the World
Bank.

 Identify opportunity for engagement. Within the investment framework

consultations and development, there seemed to have been limited opportunity for
CSO engagement, and a strategy to minimize consultations outside the Ministry of
Health and country UN agencies. This presented limited opportunities for CSO
involvement.

 Connect the national to the global. Working closely with other allied international
platforms – like the RHSC GFF Workstream - helped national CSOs to secure
participation in the national GFF process. This interaction also allowed national CSOs
to receive mentorship and technical assistance from international partners with
targeted advocacy briefs, write ups and timely information on the GFF

 Work with the Ministry of Health. Given the very tight timescales, it is important,
that CSOs act with urgency to engage with the relevant individuals within the
government, especially from the Ministry of Health (MOH) and in-country World Bank
office. CSOs should reach out to the MoH and the World Bank as soon as a country
gets an official invitation to develop a national investment case framework.

 Work with other stakeholders. While many RH advocates will have a natural
relationship with the Ministry of Health (MoH), much of the GFF country approach will
also be led by the Ministry of Planning or Ministry of Finance, and the World Bank
country office. It will be important to reach out to these stakeholders.

 Understanding GFF materials. It is crucial that national CSOs understand the GFF
Concept Note, Business Case and other materials in detail, as well as reading key
advocacy briefings and other materials prepared by international CSOs and
colleagues such as the RHSC and IPPF which outline key advocacy messages.

 Know your context. It is important to have in-depth knowledge of the current local
context, related country frameworks and statistics, as they are the most powerful
tool for evidence-based advocacy with decision makers. This advocacy must be
specific to the national, sub-national context and relate to universal health coverage.
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4. Tips for successful CSO engagement

The Kenya and Tanzania GFF country experiences yielded lessons to help others engage
more effectively with the GFF process. As each country context is different, kindly treat the
following points as TIPS ONLY!

 Coordinate CSO leadership. As a CSO, it is important to get organized, either

through existing mechanisms or by creating new coalitions. CSOs can orient each
other on the process, build consensus around channels to use, and develop/adapt
targeted, evidence-based advocacy messages.

 Actively link the national to the global. Actively participate in global and south-
south discussions (e.g. the RHSC GFF works stream calls) that link global discussions
with the national process. This platform has been used for international partners and
national CSOs to share intelligence, proving useful to CSOs ahead of national
consultations. Particularly in difficult contexts, using members of this community who
are engaging with the World Bank Group directly, can provide timely support.

 Devise and implement a SMART strategy. CSOs must agree among themselves
who is best positioned to engage with decision makers and key stakeholders at the
country level. This means putting in place a “Specific, Measurable, Attainable,
Realistic and Time-bound (SMART)” and effective strategy to reach key stakeholders
working on the GFF including —Ministry of Health, World Bank Group’s country office,
UN agencies—with specific messages to improve chances of inclusion of advocacy
priorities in the country investment case.

 Map all the main GFF events. Seek information about scheduled meetings and the
national process at the first opportunity: ask for the calendar of meetings, agendas,
key invitees and their role. Reach out to those who you know very well to inform
them of your key concerns and ask to use their influential positions to advocate on
your behalf. Reaching out to as many key decision makers and influencers as you
can maximize your chances of having core issues heard, articulated and acted upon.
It is unrealistic to expect one person to represent all of your interests or carry the
whole discussion.

 Ensure you get an invitation. Only a select number of CSOs will be invited to
official meetings with the MOH and World Bank Group leads. Building consensus
across CSOs on key advocacy asks is the best way to minimize missed opportunities
with any point of GFF. It is critical that RH advocates are included in order to position
inclusion of RH/Family Planning as one of the ‘best buy’ interventions in the
investment framework.

 Work closely with the World Bank country office. The GFF country approach will
be coordinated by the World Bank country office. In most cases, a consultant(s) will
be hired by the World Bank to facilitate the GFF country consultative process and
development of the investment framework. These experts are likely to be from
amongst your circles, and well known to national advocates. CSO engagement
meetings with consultants are a useful way of sharing knowledge on CSO core issues

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of concern. We also encourage advocates to meet with FP2020 Focal Points in-
country.

 Use evidence-based advocacy. CSOs should use evidence-based advocacy. Be

respectful. Pay attention to all the speakers to ensure those present in meetings
raise pertinent issues relevant to your agenda without being too repetitive.

 Build alliances. Alliances with organizations across the RMNCAH spectrum will
strengthen credibility. CSOs that focus on women’s and youth issues should actively
be included in strategy developments and consultations.

5. GFF Key Messages for Advocates

As RH, we suggest that CSOs consider the following aspects of financing modalities:

(1) Sustainability: The GFF does not build a sustainable model for financing RH.
The GFF’s focus on domestic resource mobilization comes with a set of risks and threats
to sustainability. We are concerned that consumer out-of-pocket payments in developing
countries are currently the single greatest source of financing for health services. The
GFF’s emphasis on domestic resourcing should not inadvertently increase private out-of-
pocket financing for RH services and supplies, particularly for the poorest and most
vulnerable populations.

(2) Linkage of grants to loan funding, leading to possible further cycles of

indebtedness. As grants will be linked to loan financing through the GFF Trust Fund,
this could create future of cycles of indebtedness for governments already struggling to
finance core sectors such as health. It is generally accepted that loan/debt financing of
annually recurring operating (“current”) costs increases the overall financial burden of
those costs and risks undermining economic development unless certain factors are in
place. Put simply, as loans and market-like instruments are designed to return profits to
capital providers, they increase the net cost of development effort, which in turn
increases the burden on developing. To ensure that access to essential RH information,
services and supplies is ensured, loan/debt financing should include grants for annually
recurring operating costs. This will help countries overcome known/planned donor
disbursement delays; (a) with a donor guarantee / pledge backing; and (b) highly
concessional in the case of Least Developing Countries (LDCs).

(3) Rights-based approaches to advance SDG3 (“healthy lives”) and SDG5

(“gender equality”). The GFF business plan states the GFF will finance SDG3 “Ensure
healthy lives and promote well-being for all at all ages”, but does not propose that GFF
funding cover SDG 5, “Achieve gender equality and empower all women and girls.”
Meeting RMNCAH needs requires that the GFF respond to a range of targets included
under both SDGs 3 and 5. GFF financing should be broadened to support the range of
services covered within the two goals.

(4) Civil society inclusion for accountability at the global and national level. It is
unclear how civil society will be included in the creation of national investment cases and
health financing strategies, as well as in the development and validation of financing
plans. Civil society must be involved in any subsequent follow-up and monitoring
processes, and should be given the space and resources to undertake an independent
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monitoring role, tracking the implementation of the GFF at national and global levels and
holding governments and the donor community to account throughout RMNCAH
implementation. Although the GFF business plan mentions engagement with civil
society, there is a need for an operational model that formalizes the engagement of civil
society (including in planning, implementation and evaluation at the national level) and
ensures this is consistent and meaningful. We call on CSOs to work in partnership with
governments, and call for CSO representatives on national GFF implementation
oversight committees.

6. Conclusion
Now is the crucial time to take action on the GFF, especially for CSOs in eligible countries.
There are many people ready to support CSO engagement with updates and information,
materials and lessons from their own engagement experience. There is a need to formalize
accountability mechanisms for the GFF at national and international levels. CSOs have an
important role to play in calling for accountability and proposing mechanisms. It is
important to note that further announcements about the GFF are expected during
September’s United Nations General Assembly, so look out for news.

For more information

World Bank website: http://www.worldbank.org/en/topic/health/brief/global-financing-
facility-in-support-of-every-woman-every-child

For further information please contact IPPF: Erica Belanger ebelanger@ippf.org

Acknowledgements: This briefing paper was developed with support from the International
Planned Parenthood Federation (IPPF), Advance Family Planning (AFP) Initiative of the Bill &
Melinda Gates Institute on Population and Reproductive Health with Johns Hopkins
Bloomberg School of Public Health, the and Reproductive Health Supplies Coalition (RHSC).
It was written by Angela Mutunga, Jhpiego, AFP Kenya, Halima Shariff, and Center for
Communication Programs, AFP Tanzania, Beth Fredrick, AFP and, Erica Belanger, Preethi
Sundaram and Alison Marshall, International Planned Parenthood Federation (IPPF). The
authors thank the Reproductive Health Supplies Coalition (RHSC) for supporting ongoing
efforts related to the GFF.