The Strength of the Global Financing Facility: Pushing the Global Envelope for Women, Children and Adolescents in the Era of Sustainable Development

Abstract

Background The Global Financing Facility (GFF) was launched in July 2015 to accelerate progress on the Sustainable Development Goals (SDGs) towards scaled and sustainable financing for Reproductive, Maternal, Newborn, Child and Adolescent Health and Nutrition (RMNCAH-N) outcomes, by increasing efficiency, mobilizing public domestic resources, linking and aligning concessional financing and external resources, and leveraging the private sector. The objective of this study is to assess the impact of expanding and scaling-up GFF support in countries. Methods The impact of scaling-up coverage of prioritized RMNCAH-N interventions in 50 high-burden countries between 2017 and 2030 was modelled through several scenarios. Two scenarios were constructed to reflect a range of conservative and ambitious assumptions around the resources that could be mobilized by the GFF model based on a Trust Fund amount of US$2.6 billion (US$2 billion additional investment for 2018-2023 and US$600 million already committed by the GFF Trust Fund). The potential impact of the GFF model was derived by contrasting health outcomes expected under these scenarios compared to a scenario reflecting either continuation of historic trends or no changes in coverage from 2016 to 2030, and the gap in impact between these scenarios compared with countries reaching 90% coverage by 2030. Resource availability projections were developed using an Excel-based model and health impacts with accompanying costs were estimated using the Lives Saved Tool (LiST) module (Version 5.69 b9). Findings The GFF investors would be able to mobilize US$50-75bn in additional funds compared to those needed to maintain the current historic-trends, expand delivery of life-saving health interventions in high-burden countries and reach coverage rates of atleast 70% for most priority interventions by 2030. This would avert between 11.9 to 34.7 million deaths among mothers, newborn, children and preventable stillbirths compared to a continuation of historic trends in coverage or to no change in coverage from 2016 onwards. Additionally, between 97.7 to 275.7 million cases of stunting, would be prevented when compared to either a continuation of historic trends in coverage or to no change in coverage from 2016 onwards. Under-five and neonatal mortality are both estimated to decrease by 34% with the stillbirths declining by 32-33% if compared to no change, or 17-18%, 19%, and 21-23% respectively, relative to continuation of historic trends. Interpretation The GFF is an innovative financing model that will go a long way pushing the envelope and closing the existing resource gap for surviving and thriving women, children and adolescents. The unprecedented opportunity to transform global health is paired with the potential reward of immediate returns, but swift and coordinated action must follow strategic planning for efficient and rapid scale-up with a commitment to transform health through the country-driven GFF platform. Our analyses suggest that with an ambitious goal, many low-income countries will make considerable progress towards their targets, but many will not reach their SDGs by 2030 with this approach alone, without also including additional resources from scaled-up private sector financing, which were only partially included in these estimates. Therefore, commitment to this new financing model for the SDG era and continued innovative financial, systems and programmatic investment. Funding: This work was supported by the Global Financing Facility. Declaration of Interest: Co-authors, Maria Eugenia Bonilla-Chacin and Kimberly Boer, are employees of the Global Financing Facility and Damian G. Walker and Sophia Magalona, work for the Bill & Melinda Gates Foundation, an investor in the GFF.