The global health financing landscape has drastically changed since the end of 2019. The emergence of Covid-19 dramatically increased the need and urgency for investment in global health and additional funds have been needed to respond to the pandemic and its direct and indirect consequences.
Overall, countries around the world are not on track to meet the World Health Organization’s Sustainable Development Goal of reducing maternal mortality. While the global maternal mortality rate fell 38% from 2000 to 2017 — a significant achievement — this is still less than half the annual rate needed to achieve the goal of less than 70 deaths per 100,000 live births by 2030.
In many countries, the lack of access to universal basic health care has hampered the pandemic response, while the pressure of Covid-19 has overwhelmed vulnerable systems, undermining the provision of maternal and child health and the administration of routine vaccination programs. These setbacks are likely to affect child and population health for years to come and reverse hard-won gains.
Now more than ever, it is essential that those working in global health financing, advocates, policymakers, and international development banks think strategically about expanding the pool of funds available and using them effectively, in real partnership with the countries they are seeking to support. The Global Financing Facility for Women, Children, and Adolescents might be able to provide a model and road map to achieve just that.
Investing in women and girls
The Global Financing Facility, created in 2015, is a partnership backed by a multi-donor trust fund housed at the World Bank. It aims to support governments in prioritizing and scaling up investments in reproductive, maternal, newborn, child, and adolescent health, and nutrition.
The GFF has pioneered a shift from traditional development approaches to a more sustainable path forward in which countries — rather than donors — lead and are incentivized to increase and maximize the use of domestic financing and external support for better, more sustainable health outcomes. Through the GFF, governments can direct domestic, World Bank, and donor resources to programs with the greatest impact to accelerate investment in reproductive, maternal, newborn, child, and adolescent health, and nutrition.
An added value of the GFF is that it is a catalytic financing instrument that crowds-in funding from various sources, meaning that the economic growth brought about by high-impact investments in a country encourages private donors to contribute, too. In this way, the GFF mobilizes additional funding from the International Development Association, the World Bank’s arm for low-income countries, the International Bank for Reconstruction and Development, and additional domestic and donor resources. It is strategically placed to garner resources from a broader range of partners and to ensure that those resources are aligned for maximum impact. To deliver on primary health care and better integrate reproductive, maternal, newborn, child, and adolescent health, and nutrition into overall health systems, the GFF provides a model for the delivery mechanism countries need.
Reclaiming the gains lost to Covid-19
Given that women and girls have been hit hardest by the pandemic, it is essential to ensure their access to health services is protected. The pandemic must not be addressed in ways that allow other critical health services to fall by the wayside.
“We cannot be forced to decide between core health services for women, children, and adolescents and fighting Covid. That is a false choice because we need to do both,” said Joanne Carter, executive director of RESULTS Educational Fund and chair of the ACTION partnership, when she spoke at a recent GFF event.
In response to Covid-19, the GFF has stepped up its support to help partner countries develop integrated and equitable country response plans, adapt and protect frontline services, and strengthen health system capacity for the delivery of Covid-19 vaccines in partnership with the ACT-A Accelerator. The GFF launched a resource mobilization campaign to raise $1.2 billion to protect essential health services and advance a more resilient and inclusive recovery. In this way, the GFF has played a key role in protecting and maintaining reproductive, maternal, newborn, child, and adolescent health, and nutrition services during the pandemic and strengthening health systems’ capacity to deliver vaccines.
As the pandemic, vaccine inequity, and disruptions in health services continue, the case for investing in such a mechanism remains clear and urgent.
Back words with action
The fight for the rights of women and children around the world has gone on for decades. As H.E. Kitty van der Heijden, vice minister for international cooperation at the Ministry of Foreign Affairs in the Netherlands, so powerfully put it, “Put your money where your mouth is and reclaim the gains.” It’s past time, she said, to “reclaim the right of women to a life in dignity because we’re delivering at present a broken dream.”
In a world in which lives are under imminent threat from climate change, wars continue to rage, and innocent lives are lost due to poor policy choices, rhetoric must be turned into action.
Given the initial success and expansive reach of the Global Financing Facility, this mechanism must be fully funded, backed by civil society, and paired with locally informed systems to measure outcomes and impact on reproductive, maternal, newborn, child, and adolescent health, and nutrition and sexual and reproductive health.
Healthy women and children are part of the foundation of healthy societies, thus the returns on investment are felt by entire communities and countries. Whether seen from a rights-based or economic-development approach, the need remains the same: invest in the health of women and children.
Vineeta Gupta is a maternal and child health physician, a human rights lawyer, and director of the ACTION Secretariat. Philippa Whitford is a breast cancer surgeon, a member of the U.K. Parliament representing Central Ayrshire for the Scottish National Party, and chair of the All-Party Parliamentary Group on Vaccinations for All. Neither author reports having a direct connection with the Global Financing Facility for Women, Children, and Adolescents.