FBOs and innovative financing for uhc by Prof Dr Khama Rogo, IFC
1. FBOs AND INNOVATING FINANCING
OF UHC: GLOBAL FINANCING
FACILITY
IN SUPPORT OF
EVERY WOMEN EVERY CHILD
1
2. • 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 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)
3
4. -
5
10
15
20
25
30
35
40
2015 2030
BillionsUS$
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
4
RMNCAH financing needs in 63 low- and lower-middle-income Countdown countries
5. 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
5
6. 6
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
7. 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
7
8. 8
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
9. Agenda
• A Global Financing Facility for RMNCAH
• GFF operating model
10. 10
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
11. 11
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
Nationalstrategicframework(s)
InvestmentCase
Governmen
t
Donor
1
Donor
2
GFF Trust
Fund + IDA
Gavi or
GFATM
12. 12
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/outco
me 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
13. 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
13
14. 14
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
• ~$18.6 bn in 2014 for all sectors
GFF Trust Fund
• Pooled resources
from multiple
donors
• Grant financing that
can be used flexibly
• Eligibility criteria
specific to the fund
15. 15
Scaled: increasing efficiency through increased use of pooling
and shared management
Donors at
country level
Multi-donor
trust fund at
country level
Single-donor
trust fund at
country level
Parallel
financing
Government
Globally
pooled
resources from
GFF TF and
IDA/IBRD
Globally
pooled
resources from
Gavi and
GFATM
Pooled
resources
(with
government)
Over time, increased pooling at global level
Sourcesof
financing
Over time, increased use of shared management at country level
Mechanisms
16. Scaled: engaging new partners in RMNCAH: private sector
• Attract additional resources:
– Pay-for-performance schemes: social/development impact
bonds
– Co-investing/loan guarantees
– Public-private partnerships (e.g., mHealth)
• Support existing resources to operate more effectively
– Address coordination and information challenges
– Bridge funding
16
17. Sustainable
• Basic proposition of the GFF:
– RMNCAH often receives a disproportionately low share of
domestic resources (and does not capture appropriate share of
economic growth)
– Not possible to achieve 2030 goals without significant increase
in domestic resource mobilization (DRM)
17
-
5
10
15
20
25
30
35
40
2015 2030
BillionsUS$
18. 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)
Equity
18
19. 19
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
FormalInformal
20. Which Way FBOs?
Taxation
Airline
Money transfers
Sin
Philanthropy
Local
Insurance
CBHI
SHI
Business models
Social franchising
SMART FINANCING
Predictable
Efficient
Scalable
Sustainable
20