The Global Financing Facility in support of Every Woman Every Child (GFF) has launched its call for a 2018 replenishment with a target of raising $2 billion from donors. This mechanism, hosted at the World Bank, aims to support investment in health, specifically in support of the Global Strategy for Women’s, Children’s and Adolescents’ Health.
The GFF is a curious beast. Emphatically it is not supposed to become a new global fund – although the call for replenishment may feel like that. $2 billion is a large amount but not compared to the amounts that Gavi, the Vaccine Alliance, ($7.5 billion) and the Global Fund to Fight AIDS, TB & Malaria ($12.9 billion) raised in their last replenishments. Gavi and the Global Fund have definitely helped countries but there are many questions about their sustainability, as this report by our friends at Results asks. As countries ‘transition’ from this support, will they have the budget to start to replace external aid or will the gains rapidly reverse?
The GFF aims not to create any more dependence on donors, an objective we strongly support. The replenishment is for the Trust Fund element of the GFF, which does allocate cash to countries. To maximise resources in the short term, GFF Trust Fund recipient countries also agree to use loans that they can access from the World Bank or the International Bank for Development and Reconstruction (IDRB) to finance health and nutrition expenditure. While it is right that countries can borrow to invest, we have seen problems with countries taking on too much debt in the past. There are also important questions about sustainability if everyday health service costs are paid for by loans.
The GFF also aims to align donor aid behind national health plans – something that has long been a commitment from donors but without a stunning track record of success.
Finally, as part of the agreement, GFF recipient countries are meant to increase resources for health from their own domestic budgets by improving taxation and investing in health. It is this money that would be the largest, most sustainable and fairest way to build Universal Health Coverage in the long-term and end preventable child deaths, for example. As such, this is the most important element of the GFF model and will also likely be the most difficult. Analysis from WHO shows that domestic resources for health have largely stagnated and the promised move from out-of-pocket payments to government pooling has not yet materialised. Many governments appear far happier to receive donor money than to address poor taxation systems and illicit financial flows.
Save the Children supports this replenishment because we believe that the GFF model could prove successful and could help avoid the historic problems of donor dependency and indebtedness. More than $2bn might risk increasing dependency on donors. Less than $2bn might not incentivise governments to increase their domestic resources. However, if the model is to be fully realised, the goal of increasing domestic resources for health must be the top priority, with concrete wins in the short-term, not vague long-term aspirations.