A mother and her child seek treatment at a clinic in Harper, Liberia (credit: ACTION/Tom Maguire)
With their adoption of the Sustainable Development Goals, world leaders committed to achieving specific targets by 2030 related to reproductive, maternal, newborn, child, and adolescent health plus nutrition (RMNCAH+N). Delivery of these targets requires substantial investments through national and international commitments and accountability in budget allocation and spending.
Global health interests including government leaders, technical and development partners, policymakers, academics, civil society, and people from affected communities, met in Oslo, Norway, November 3-6, to address resource mobilization for RMNCAH+N targets through the Global Financing Facility (GFF) in support of Every Woman Every Child.
The GFF is an important mechanism for the delivery of funding to improve the health and quality of life for women, girls and adolescents. It offers the possibility and opportunity to enhance both domestic and external support for RMNCAH+N in implementing countries to ensure smart, scaled-up, and sustained financing with a focus on results.
Most GFF implementing countries in Africa have made remarkable improvement in RMNCAH-N outcomes during the last decade. In Kenya, for example, child mortality has declined by over 20 percent since 2008, and the country achieved a total fertility rate of less than four per woman. Six out of ten pregnant women now receive skilled care at childbirth, and more than half get postnatal care. Stunting, which remained stubbornly high over the past two decades, has started to decline.
However, many women, newborns, children, and adolescents in these countries continue to suffer or die from conditions that are preventable or treatable. Access to quality, timely, and affordable RMNCAH+N services remains a challenge across all levels of care, while geographic, population sub-group, and economic inequities persist.
Since the launch of the GFF in 2015, civil society in implementing countries have continued to share their vision for “the GFF we want” towards making progress on universal health coverage (UHC) by putting women, children, and adolescents first. That is truly country driven by and focused on and results to ensure equitable access to affordable RMNCAH+N services. And, that stays true to the aspirations of leaving no one behind.
In the lead up to this replenishment of the GFF, WACI Health and the ACTION Global Health Advocacy Partnership facilitated a regional consultation among civil society in a sampling of implementing countries in Africa. The consultation aimed at elevating the voice of civil society and embed lessons learned by GFF implementing countries through the GFF replenishment and ongoing resource mobilization. Separately, a "GFF We Want" questionnaire was administered in order to capture civil society’s voice, and it yielded valuable insights into what they see as the added value of the GFF, as well as how the facility can be most effective.
Among the imperatives, as highlighted in the responses, that would make the GFF the most effective are:
- ignite political will and human resources to improve RMNCAH+N outcomes;
- increase financing for the health sector, getting government at all levels to commit and invest more cost-effectively;
- provide an opportunity to strengthen the coordination mechanisms and multi-stakeholder approach by bringing a wide range of development partners to the table;
- support a country-driven and results-focused approach to equitable access to affordable minimum package of RMNCAH+N, thus contributing to progress towards UHC;
- increase domestic resources by implementing governments;
- engage civil society in country processes at different levels; and
- encourage results and positive outcomes through performance-based financing in some countries.
The civil society perspectives are inspired by the GFF’s guiding principles: equity, inclusiveness, transparency, efficiency, and accountability. This is an acknowledgment that resources on their own will not deliver on the GFF promise outside of these principles.
Overall, global health players — government leaders, technical and development partners, policymakers, academics, civil society, and people from affected communities have a role to play in ensuring that the GFF is well-resourced as well as to assure that implementation complies with the guiding principles. Only then will its potential be optimized — and its promise to women, girls, and adolescents realized. The US$1 billion pledged to the GFF Trust Fund, yesterday, is only the beginning. We will need more resources to make this happen and that includes resources for civil society to carry out its important role.
Rosemary Mburu is executive director of WACI Health.
 Kenya, Ethiopia, Uganda, Tanzania, Mozambique, Rwanda, Burkina Faso and Liberia