Monique Vledder, the head of the Global Financing Facility (GFF) Secretariat, served as the guest speaker for the second GFF seminar. JCIE launched the GFF Seminar series in 2020 as part of its efforts to deepen understanding of how the Japanese government, NGOs, and others can coordinate more effectively with the GFF in order to strengthen maternal and child health and expand universal health coverage in the world’s most vulnerable countries.
The GFF was established to accelerate the progress of one of the most overlooked SDG goals, RMNCAH-N (Reproductive, Maternal, Newborn, Child, Adolescent Health-Nutrition), by mobilizing greater resources as well as enhancing international and in-country cooperation. Thirty experts from the RMNCAH-N community in Japan participated in this virtual seminar, discussing the challenges that the most vulnerable countries are facing under COVID-19 and how the GFF protects essential services to save the lives of women, children, and adolescents from “secondary health crises” in those countries.
Background and role of the GFF
Dr. Vledder started her presentation by discussing the background and recent impact of the GFF. She mentioned that the GFF currently supports 36 countries across the globe (out of 67 eligible countries), with a focus on delivering comprehensive packages of essential services. The GFF analyzes the systems and bottlenecks that prevent service delivery, and it aims for long-term sustainability and financing by improving efficiency and pursuing domestic resource mobilization (DRM).
One of the unique strengths of the GFF is that it leverages its linkage to the World Bank’s International Development Association (IDA) loan program to mobilize greater financing to improve the progress on the ground. There now is an almost 1:8 ratio between GFF and IDA financing, meaning that for each yen that the GFF gives in grants, countries have been receiving an additional eight yen in loans. The GFF also aims to support countries in achieving Universal Health Coverage (UHC) by extending care to some of the most vulnerable populations in the recipient countries, namely poor mothers and children.
Serious “secondary health crisis” sparked by COVID-19
While many of the GFF-active countries have seen marked progress since the institution’s launch in 2015, Dr. Vledder stressed that COVID-19 is now causing a “secondary health crisis”. The GFF quickly conducted surveys to monitor and evaluate the impact of the pandemic to best support the countries, and these have found that at least 15 countries are experiencing major disruptions in access to essential services. In Liberia, for example, there has been a 40 percent drop in outpatient visits, including for critical services related to childhood immunization, antenatal care, and safe childbirth, and there are similar declines in Somalia and Mali. Moreover, severe economic shocks, disruptions in schooling, and gender-based violence is further impacting recent gains for women and girls. Meanwhile, other GFF analysis suggests that as many as 26 million women may lose access to contraception due to the COVID crisis – resulting in 8 million unintended pregnancies in the 36 countries covered by the GFF
GFF’s response to COVID-19
There were several approaches that Dr. Vledder highlighted as core elements of the GFF’s responses to the pandemic:
- The GFF is prioritizing the maintenance of essential services and developing measures to protect children, adolescent and women in the crisis, while staying focused on its health system strengthening (HSS) approaches.
- The GFF has also developed the country briefs for all 67 eligible countries that analyze the potential impact on the maternal and child health and made them available online in local languages.
- The GFF is working closely with the World Bank’s poverty team to assess the barriers in accessing services and design appropriate responses.
- The GFF is coordinating with partners in addressing the lack of essential commodities by supporting local production of masks and other personal protective equipment (PPE) for frontline community health workers.
- They also developed the Service Delivery Learning Program, a hands-on, action-oriented, competence-based and south-south learning program that addresses the needs and response to sustain programs on the ground. There have been three rounds of this program and most of the 36 GFF countries have participated.
- The GFF is part of the Access to COVID-19 Tools (ACT) Accelerator, focusing on HSS. They have also collaborated with the following partners in the context of COVID-19:
- A GAP enhanced partnership on the health financing front with Gavi, the Global Fund (GF), and WB.
- A partnership with PMNCH and UHC2030 on CSO engagement.
- Strong coordination and joint actions at the country level with the World Health Organization (WHO), United Nations, and bilateral agencies.
- The GFF is providing financial assistance of up to US$300,000 per country to be used by the end of 2020. These funds are to support either strengthening service delivery, coordination and planning, or health financing.
Strategy Refresh and Looking Ahead
Lastly, Dr. Vledder discussed the GFF’s current strategic planning exercise, or “strategy refresh,” explaining that is guided by the keywords of “Protect, Promote and Accelerate,” which capture the organization’s mission for the next five years. The five priority areas in the new strategy will be:
- Bolstering country leadership and accountability to prioritize investments in health for women, children and adolescents
- Protecting & promoting essential health services by reimagining service delivery
- Building more resilient and sustainable primary health care systems through more efficient and effective use and mobilization of domestic resources
- Expanding and intensifying efforts to promote equity and gender equality
- Sustaining a relentless focus on results
Dr. Vledder’s presentation was followed by an engaging discussion with the 30 participants from Japanese government agencies, NGOs, and research institutions. One participant asked about the GFF’s role in advocating to prioritize essential services rather than high-tech solutions which may not be appropriate in LMICs. In response, Dr. Vledder explained how the GFF plays an important role through its coordination with the World Bank in bringing attention to the possible knock-on effects from COVID, highlighting estimates of excess mortality due to disrupted essential services and mobilizing its partners to advocate for measures to improve access to basic services. Another question arose from a civil society participant on how the pandemic affects the GFF’s efforts to support country capacity for strengthening DRM. Dr. Vledder pointed out that many countries where health budgets were particularly low prior to the pandemic had quickly expanded domestic funding for health in the response to the pandemic. She also noted how CSOs play an important role in advocating for vulnerable populations who have been severely impacted by the pandemic. In closing, several participants showed high expectations for what the GFF can contribute to improve the lives of millions of mothers, children and adolescents around the world.
MONIQUE VLEDDER, Head of Secretariat, Global Financing Facility (GFF)
DAVID K. BRIDGES, Senior Partnership Specialist, GFF Secretariat
NORIKO FUJITA, Director, Department of Global Network and Partnership, Bureau of International Health Cooperation, National Center for Global Health and Medicine (NCGM)
MARIKO FUKAO, Deputy Director, Health 3 Team, Human Development Department, Japan International Cooperation Agency (JICA)
JAMES GANNON, Executive Director, JCIE/USA
REI HARUYAMA, Technical Officer, Department of Global Network and Partnership, Bureau of International Health Cooperation, NCGM
CHIHIRO HIRASAWA, Operations Analyst, The World Bank Group Tokyo Office
YUMIKO HORIE, Advocacy Manager, Save the Children Japan (SCJ)
SATOMI ICHINO, Researcher, Global Health Policy Division, International Cooperation Bureau, Ministry of Foreign Affairs
EMI INAOKA, Special Assistant for Global Health Issues, Global Health Policy Division, International Cooperation Bureau, Ministry of Foreign Affairs
SUMIE ISHII, Chairperson, Japanese Organization for International Cooperation in Family Planning (JOICFP)
MIWA ITO, Deputy Director, Health 1 Team, Human Development Department, JICA
MIHOKO KASHIWAKURA, Head of Japan, Bill & Melinda Gates Foundation
YASUMASA KIMURA, Director, UNICEF Tokyo Office
KIYOSHI KODERA, Chair of the Board of Trustees, Water Aid Japan; Senior Research Associate, Overseas Development Institute (ODI), United Kingdom
DAIKICHI MOMMA, Executive Advisor, Nippon Life Insurance Company
MAKO NAGAO, Health 3 Team, Human Development Department, JICA
SHIORI NAGATANI, Program Officer, JCIE/Japan
HIROSHI NAKA, Professor, Institute for Future Initiatives, the University of Tokyo
RISA NAKAYAMA, Health Communication Specialist, The World Bank Group Tokyo Office
HIROMI OBARA, Deputy Director, Division of Global Health Policy and Research, Department of Health Planning and Management, Bureau of International Health Cooperation, NCGM
AKIO OKAWARA, President & CEO, JCIE/Japan
DAISUKE OURA, Special Officer for Global Health, Development Policy Division, International Bureau, Ministry of Finance
HARUKA SAKAMOTO, Project Researcher, Department of Global Health Policy, Graduate School of Medicine, the University of Tokyo
TOMOHIKO SUGISHITA, Professor, International Affairs and Tropical Medicine, Tokyo Women’s Medical University
TOMOKO SUZUKI, Chief Program Officer, JCIE/Japan
IKUO TAKIZAWA, Deputy Director General, Human Development Department, JICA
RIE TAKESUE, Health Specialist, UNICEF Tokyo Office
MALETELA TUOANE-NKHASI, Focal Point for Kenya, GFF Secretariat
ETSUKO YAMAGUCHI, Chief Program Manager, International Program, Japanese Organization for International Cooperation in Family Planning (JOICFP)
TOMOKO YOSHIDA, Senior Program Officer, JCIE/USA
KEIKO WATANABE, President, BridgeK, Inc.