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Skip to 0 minutes and 17 seconds DR MARIAM CLAESON: As you know, we are moving into, or have moved into the SDG (Sustainable Development Goals) era. We have very ambitious goals and targets for maternal survival and maternal health, to actually eliminate all preventable maternal deaths, which can be done. But that requires really a focus on how do we reach those who have not yet been reached with quality maternal health care, quality services at the antenatal period, intrapartum, and postpartum period. And that requires major investments. It requires that you really look, as we do, across the reproductive, maternal, newborn, child health and adolescent health continuum, and cost that.

Skip to 1 minute and 1 second And what we have estimated is that to really cover reproductive, maternal, newborn, child, and adolescent health and nutrition costs about $33 billion US dollars a year. For the past few years it’s cost the world about $36 billion is what’s been invested overall in the health sector. So that’s a large share of what we invest in health. So in 2015, the global community decided that this really called for a new way of doing finance, financing for development. So the global financing facility was launched in Addis Ababa in 2015 as a new way of financing.

Skip to 1 minute and 42 seconds And when I say new way of financing for development, and financing particularly the services we’re talking about now, including quality services for mothers, then you need to really look at what are your priorities across this continuum. You need to think about how you can mobilise resources, when ODA and development aid is most likely to be flat over the next few years and into the future. So how can you help countries have a country-driven investment case that prioritises the most critical and high impact interventions and approaches? And then look at how can I improve efficiency? And of course, around maternal and newborn child health, there’s enormous efficiencies that can be gained.

Skip to 2 minutes and 30 seconds We estimate that countries, even their current budgets, they only spend about maybe 60%, 70% of their budgets. So how do we improve your spending of the money you have, and of course, get quality for the money, value for the money? But then, how do you use domestic resources? How do you mobilise money from the private sector, crowding the private sector money? How do we get bilateral aid that currently is very fragmented? How do we get bilateral donors, funders, and partners to align around that one investment case and really put their resources around that one case so you really align, and harmonise, and get the spending to be focused?

Skip to 3 minutes and 15 seconds So in order to ensure that countries have smarter, scaled and sustainable financing, we combine the efficiency gains, domestic resources, crowding-in public/private money, and linking it to concessional financing from the World Bank. That’s the only way you can really get to scale as well as sustainable financing. And to date, about $1 spent from the Global Financing Facility (GFF) trust fund has been matched and linked to $4 of World Bank financing. So we estimate, or we have right now, spent around $292 million of the GFF trust funds and linked that to $1.3 billion of World Bank financing.

Skip to 4 minutes and 5 seconds So the countries that have been sort of the front runners – 16 countries to date– what they do is, first of all, create a country platform. This is truly a country-driven financing mechanism. And that’s why it’s very different from other global financing facilities and mechanisms. So you start with bringing the partners together, the UN partners, the international NGOs, bilaterals, civil society, and together, using evidence and an equity lens, you prioritise. And if you prioritise across reproductive, maternal, newborn, child, health, and nutrition, you end up, of course, identifying those most critical bottlenecks. So some investments are direct investments. For example, in maternal health, it means getting the right supplies that you need in order to provide essential care.

Skip to 4 minutes and 55 seconds But it also means some indirect critical bottlenecks that you have to adjust, like manpower. Do you have skilled birth attendants? Do you really reach out to those that are most in need? So that’s part of that prioritisation. Then when you have a very strong investment case, a prioritised plan, and some countries already have five-year plans, so they look at those and try to refine them and sharpen them. Then we look at how do we take this to the Minister of Finance? So part of the GFF’s work is both to support the prioritisation, but also really working with ministers of finance around health finance reform.

Skip to 5 minutes and 34 seconds And that means, for maternal and newborns, anything from, first of all, do you have the skilled birth attendants? Do you have antenatal services that’s not just about context, but about quality and content? Do you have in place a mechanism for transportation? All those most critical bottlenecks are being addressed as part of this. And it’s been interesting to see to date what countries have done with the GFF financing. So in Tanzania, they want to make sure that there are a hundred more facilities that can really provide quality CEmOC (Comprehensive Emergency Obstetric Care), which means also blood supplies. So they are using the World Bank, the GFF World Bank financing, for blood supplies in order to actually do CEmOC in Ethiopia.

Skip to 6 minutes and 25 seconds What they want to do, again adding an equity lens here, is the lagging part of the country, which has the poorest indicators, how can they bring skilled birth attendants to those areas. In West Africa, you know, a place like a country like Liberia, who has just come out of the Ebola crisis, wants to build resilience in the northern part, which means also providing care for mothers and newborns. For us it’s been interesting to see that if you look at burden, and you look at the neglected areas– neglected communities, neglected population groups, adolescents who get pregnant, or you look at neglected services, countries identify family planning, nutrition, and interventions around birth.

Skip to 7 minutes and 14 seconds So that’s really what the GFF is trying to do, is secure smart, scaled, and sustainable financing. So what we’re learning from the first countries that have used the GFF facility to support reproductive, maternal, newborn, child, and adolescent health and nutrition is really how they plug in family planning, but also skilled birth attendance and antenatal care as part of results-based financing (RBF). It’s one of the key indicators in all the so-called results-based finance or RBF projects. Because each of these GFF-funded countries also usually have an RBF component.

Skip to 7 minutes and 54 seconds I think some of these– what we refer to, the front-line countries– are making progress because they have moved from creating or developing a strong investment case for maternal and newborn care to the implementation phase. And the countries that are ready, sort of from investment case to implementations, are Liberia in building resilient primary health care system, which includes, of course, services for mothers and newborns. Another country that’s ready and is sort of in the front line, shifting from investment case and developing your case to implementation, is Tanzania, with investment in 100 facilities, including blood supplies, in order to provide CEmOC. And both Uganda, Kenya are other countries that are shifting towards implementation phase.

The Global Financing Facility: an approach to address maternal health financing

What is the critical need for financing maternal health, and what is the Global Financing Facility’s approach to achieving this?

In this step Dr Mariam Claeson (GFF) describes the Global Financing Facility approach to financing maternal health. The GFF seeks to improve the efficiency of spending; using domestic and private sector sources; donor alignment; and smart, scaled and sustainable financing linked to World Bank concessional financing. Examples are highlighted of promising country-led initiatives to develop the most high-impact interventions to improve maternal health.

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The Lancet Maternal Health Series: Global Research and Evidence

London School of Hygiene & Tropical Medicine