Kenya health advocates -Civil Society Organizations (CSOs) and Youth Led Organizations (YLOs)- in the Global Financing Facility (GFF) space under the leadership of Health NGO’s Network (HENNET) have urged stakeholders to ensure that the Phase 2 of the Reproductive, Maternal, Newborn, Child, and Adolescent Health and Nutrition (GFF RMNCAHN) Investment document that the country is working on outlines Kenya’s roadmap to transition into 100 percent domestic financing inorder to sustain the gains made by planning ahead of how we will self-finance the programs after the donor (GFF/World Bank) exits.
At a CSO/YLYOs specialized training package for Kenyan CSOs/YLOs Kenya regional representatives on GFF architecture and processes, an assessment report commissioned by HENNET highlighted that that despite of implementation of the Kenya 2016 RMNCAH Investment Framework, from 2016-2023, Kenya in a GFF investors group meeting held in Nov in Nairobi, reported a high rate of Maternal Mortality Ration standing at 355 per 1000 live births against an SDG 3.1 target of less than 70 per 1000 live births. Additionally, still births increased from 13 per 1000 live births to 15 to 1000 live births against the ENAP target of less than 12 per 100 live births by 2030.
“Existing barriers still affects access to quality health services, including midwifery care, realization of rights and gender equality, better nutrition, access and utilization of family planning services water and sanitation, sound domestic financing model need to be in place to avoid gains being reversed after the GFF exit”, Hennet said.
According to HENNET, the GFF partnership, have provided both financing and technical assistance to support RMNCAHN quality improvements, alignment, financing, and implementation of annual county work plans.
“GFF aims was to improve utilization and access to quality health care services in order to improve the RMNCAHN health outcomes and realization of UHC.”
According to HENNET other worrying trends include the declining rate of exclusive breastfeeding rates from 60 to 61 for the 1st six months, increasing burden of non-communicable diseases, among women and adolescents and gaps in policies, infrastructure, human resources for health, and commodities and supplies.
“There is a need to sustain the gains made by planning ahead how we will finance the RMNCAHN programs domestically in Kenya, while committing more resources to high impact interventions with measurable outcomes in support of the Sustainable Development Goals (SDGs), as part of efforts to sustain and improve accountability and monitoring of the delivery of RMNCAH services.”
HENNET also asks that the Kenya Multistakeholder Country Platform (MCP) chaired by Dr. Patrick Amoth to ensure county consultations are conducted in all the 47 counties to identify the key needs of Kenyans in RMNCAHN to inform development of phase 2 of the Kenya RMNCAHN Investment into GFF.
The lobby group also want GFF Multistakeholder Country Platform (MCP) to ensure that the re-investment process is fast tracked so that the investment can be reflected in annual development plans (ADPs) latest in the budget year 2025/2025 or earlier and also ensure that adolescent and youth Sexual Reproductive Health (SRH), Nutrition and gender responsible indicators are given precedence.
In Kenya the GFF/ world bank group (WBG) financing has helped to scale up high-impact interventions and reforms to accelerate RMNCAHN health outcomes, Sharon explained.
According to a presentation made by Kenya’s health, Cabinet Secretary (CS), Nakhumicha S. Wafula, on 8 years of Kenya’s Partnership with the GFF on 17TH GFF Investors Group Meeting held in November 29th -30th -2023, the CS commended the public health impact of GFF investment saying that, as of June 2023, at least 14.7 million people received essential health, nutrition, and population services, 7.3 million children immunized, 7.4 million deliveries attended by skilled health personnel.
The GFF 2016 Investment Case, often referred to as the World Bank/THS program, officially concluded on September 30, 2023. However, it was noted that Kenya, through the MCP, had already made plans to reinvest in the GFF.
Given the remarkable progress made by Kenya in meeting the necessary requirements for additional funding based on the last disbursement of Transforming Health Systems for Universal Care Project, which closed in September, The GFF provided Technical it is likely that the country will qualify for another round of funding considering that TFC has approved the second-round financing for Kenya to continue this work.
Kenya will be eligible for an allocation of GFF newly approved challenge fund. Details on the total funding envelope are forthcoming, pending the World Bank Board of Executive Directors’ decision on the co-financed project foreseen in 2024.
A case study commissioned by PAI on behalf of the Civil Society, GFF Resource and Engagement Hub (CSO GFF Hub) and civil society members represented by HENNET in Kenya in 2022 highlighted that CSOs were not adequately informed about the GFF process during the development of the 2016 RMNCAH Investment Framework and to ensure the effectiveness of CSOs adequately informed about the GFF process, HENNET engaged a consultant to conduct a thorough assessment and subsequently craft a specialized training package to capacity build CSOs and in extension other stakeholders to engage better during phase 2 of the re-investment process.
According to HENNET, the consultant expertise distilled complex concepts into accessible and actionable insights, providing CSO’s/YLO’s regional representatives with the understanding of the GFF framework so that they can disseminate the understanding of how GFF works to their respective 8 regions.
In Kenya, county governments are primarily responsible for planning and budgeting for health service delivery and HENNET want to build capacity of county led CSO’s to participate in key RMNCAHN decision making process.
In the GFF model, County governments receive funding that is tied directly to their performance on four indicators: coverage of antenatal care services, skilled birth attendance, child immunization, and use of modern contraceptives. The model creates an incentive to prioritize both the delivery and the utilization of these essential health services.
Through the RMNCAH scorecard tool, Kenya has been able to track and improve access to essential health services such as antenatal care, skilled birth attendance, and immunizations. They have also improved access to family planning services and increased the use of modern contraceptives.
Kenya’s approach to decentralizing the tool to the county level has empowered counties to take ownership of their healthcare systems and implement targeted interventions that address the unique needs of their populations.
Launched in 2015, the Global Financing Facility (GFF) for Reproductive, Maternal, Newborn, Child, and Adolescent Health (RMNCAH) is a catalytic, country-led, innovative financing mechanism, in support of Every Woman, Every Child (EWEC) initiative and the updated Global Strategy for Women’s, Children’s, and Adolescents’ Health.
Since its launch GFF financing process has catalyzed prioritization of RMNCAH+N within decentralized systems in Kenya improvements in the health indicators; engagement and coordination of all actors including civil society and other stakeholders; and enhancement of mutual accountability across all actors.
The GFF catalytic role provides details on the GFF support for Kenya’s Reproductive, Maternal, Neonatal, Child, and Adolescent Health and Nutrition (RMNCAH-N) agenda. It focuses on support provided in the areas of the Investment Case (IC), health financing and systems reforms, the country platform, partner alignment, and data use for decision-making. These aim to generate evidence and strengthen countries’ capacity to measure progress and performance of RMNCAH+N programs. They are also to inform the country’s annual and mid-term review plans and GFF investment cases.
In Kenya, the Health NGOs Network (HENNET) was identified as the platform under which health civil societies should engage in the (Global Financing Facility) GFF process. In January 2017 and under the HENNET umbrella, the RMNCAH + N CSO Coordinating Group was formed as a mechanism for engaging with CSOs in Kenya at national, and eventually, county level. The RMNCAH + N CSO coordinating group plays the fundamental role of engaging various key GFF actors at national and sub-national level.
The GFF’s innovative financing approach aims to close the financing gap needed to eliminate preventable maternal, child, and adolescent deaths, thereby achieving the Sustainable Development Goals (SDGs) related to RMNCAH+N. Additionally, the GFF mechanism aligns investments in RMNCAH+N, and supports countries efficiently utilize their allocated health resources, and increase their domestic resources for health.
GFF uses Two main vehicles to channel their support to counties through the Transforming Health Systems for Universal Care Project, which uses a results-based approach; and the RMNCAH Technical Assistance Multi-Donor Trust Fund (MDTF).
GFF model ties funding directly to performance, through the Transforming Health Systems for Universal Care Project (THS-UCP), co-financed by the World Bank and the GFF Trust Fund, county governments are encouraged to shift from a health-inputs model to a health-results model.
THS-UCP project’s eligibility criteria include a requirement that county governments allocate at least 20 percent of their budgets to health and that this percentage be increased over the previous year’s allocation if a county had allocated less than 30 percent of their budget to health.
The aim of the project was to improve utilization and access to quality health care services in order to improve the health outcomes and realization of UHC.
The GFF/WBG financing has helped to scale up high-impact interventions and reforms to accelerate health outcomes.
