FBOs and innovative financing for uhc by Prof Dr Khama Rogo, IFC

FBOs and innovative financing for uhc by Prof Dr Khama Rogo, IFC

• 1.
  FBOs AND INNOVATINGFINANCING 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 ispart 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 goalof 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 FocusAreas • 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 theGFF 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 GlobalFinancing Facility for RMNCAH • GFF operating model
• 10.
  10 The operational modelis 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 anInvestment 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 financingat 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 resourcesat 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 • ~$18.6 bn in 2014 for all sectors GFF Trust Fund • Pooled resources from multiple donors • Grant financing that can be used flexibly • Eligibility criteria specific to the fund
• 15.
  15 Scaled: increasing efficiencythrough increased use of pooling and shared management Donors at country level Multi-donor trust fund at country level Single-donor trust fund at country level Parallel financing Government Globally pooled resources from GFF TF and IDA/IBRD Globally pooled resources from Gavi and GFATM Pooled resources (with government) Over time, increased pooling at global level Sourcesof financing Over time, increased use of shared management at country level Mechanisms
• 16.
  Scaled: engaging newpartners in RMNCAH: private sector • Attract additional resources: – Pay-for-performance schemes: social/development impact bonds – Co-investing/loan guarantees – Public-private partnerships (e.g., mHealth) • Support existing resources to operate more effectively – Address coordination and information challenges – Bridge funding 16
• 17.
  Sustainable • Basic propositionof the GFF: – RMNCAH often receives a disproportionately low share of domestic resources (and does not capture appropriate share of economic growth) – Not possible to achieve 2030 goals without significant increase in domestic resource mobilization (DRM) 17 - 5 10 15 20 25 30 35 40 2015 2030 BillionsUS$
• 18.
  Sustainable: increasing domesticresources 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 fordomestic 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