MONDAY, MARCH 4, 2024, WASHINGTON D.C | Ahead of International Women’s Day on March 8, a new report released today shows that more than 90 percent of countries partnering with the Global Financing Facility (GFF) have reduced maternal mortality and under-five mortality. Major progress has also been achieved across other health outcomes — including reductions in adolescent birth rates, stunting and stillbirths — showing that long-term commitment to investing in the health of women and youth is delivering results.

New data demonstrate that:

  • Maternal mortality rates declined in 96% of countries;[1] 100% of countries partnering with GFF >5 years saw a decline
  • Under-five mortality rates declined in 94% of countries;1 100% of countries partnering with GFF >5 years saw a decline
  • Adolescent birth rates declined in 76% of countries;1 100% of countries partnering with GFF >5 years saw a decline
  • Stunting among children under five years old declined in 75% of countries;1 88% of countries partnering with GFF >5 years saw a decline
  • Stillbirths declined in 56% of countries;1 78% of countries partnering with GFF >5 years saw a decline

The report also shows the longer countries work with the GFF partnership, the stronger the progress. Countries partnering for 3+ years have seen coverage of four or more antenatal care visits (ANC4+) and family planning improve by 41.5 percent and 29.9 percent respectively, compared with countries partnering for 1 to 3 years seeing improvements of 1.3 percent and 8.5 percent respectively.[2] Against a backdrop of stagnating progress, results are notable in countries working with GFF compared to countries that are eligible but not yet supported..[3]

Despite huge gains in bolstering health systems and improving the health outcomes of women, children and adolescents, significant investment is still needed to build on these advances and overcome challenges. We have no time for complacency. Multiple crises — including worsening climate events such as cyclones and drought that disrupt health services and destroy farmland and homes — are leaving the most at-risk women and youth even more vulnerable. This is particularly concerning for the more than 40 percent of partner countries categorized as fragile and conflict-affected settings.

Country highlights

The partnership with the GFF is contributing to women’s, children’s and adolescent health in each country in multiple ways. In a few examples:

  • Tanzania has more than doubled the percentage share of its budget allocated to health (from 8.1% in 2016 to 16.5% in 2022) and reduced maternal mortality rates by 82% since 2015.
  • Côte d’Ivoire has scaled up a performance-based financing program to districts with lagging health outcomes, channeling more resources to community health facilities (public and private).
  • Kenya is piloting mobile civil registration units in remote areas to accelerate birth and death registration and ensure all women and children are counted in national systems, among other measures.

Luc Laviolette, Head of the GFF Secretariat, said: “The evidence is clear: This country-led approach is delivering progress in improving health outcomes for women and children. However, many governments across the world, including 35 of the 36 GFF partner countries, are still off-track in meeting the 2030 goals for maternal, newborn and stillborn mortality reduction. The international community must come together and step up its support.”

The GFF is working with partner countries across five key areas:

  • Bolstering country leadership to ensure country ownership and prioritization;
  • Advancing equity, voice, and gender equality, supporting countries to be more precise in their targeting strategies to reach the poorest women, children and adolescents;
  • Promoting high-quality essential health services by reimagining service delivery;
  • Building more resilient, equitable and sustainable health financing and working with countries to prioritize health and nutrition in the budget expenditure; and
  • Sustaining a relentless focus on results, including partnering with countries to improve their use of data for decision making, improve their results reporting and increase transparency.

A critical moment for investment

With countries facing economic, humanitarian, and climate shocks, health systems and government finances face further strain. According to World Bank analysis, these compounding crises could lead more than 40 governments[4] to spend less on health between now and 2027 than they did before COVID-19. Urgent investments in health systems are needed to build on progress and prevent a backslide. The GFF’s “Deliver the Future” campaign continues after governments and philanthropies contributed US$445 million in funding during the first pledging event of the campaign at the World Health Summit in October 2023. A fully funded GFF will be able to secure access to essential health services for 250 million women, children and adolescents in the hardest-to-reach communities.

ENDS//

Notes to editors:

Contact

Sheryl Silverman: ssilverman@worldbankgroup.org, +1 410.868.4664
Nansia Constantinou: nconstantinou@worldbankgroup.org, +1 202.492.0096

About the Global Financing Facility (GFF)

The GFF is a country-led partnership, hosted by the World Bank, that fights poverty and inequity by advancing the health, rights and opportunities of women, children and adolescents. It does this by supporting low- and lower-middle-income countries to strengthen their health systems and improve the quality of and access to health care through prioritized plans, aligned financing, and policy reform. The GFF’s collaborative model brings together a wide range of partners — from bilateral and multilateral funders, partner countries, and global health institutions to civil society organizations (CSOs), youth representatives, and the private sector — to align their support around country priorities for women, children and adolescent health. Through its 2021–2025 strategy, the GFF supports governments to make impactful investments across key strategic directions to accelerate progress toward better health for women, children and adolescents and build more inclusive and resilient health systems. As of June 30, 2023, the GFF Trust Fund committed a total of US$1.45 billion for grants in 38 countries. Out of this amount, a total of US$1.19 billion linked to US$8.75 billion in World Bank IDA/IBRD has been approved by the World Bank’s Board of Executive Directors

More detail with country examples:

The partnership between the GFF and countries is responsive to needs and priorities in geographies, and is multifaceted:

In Tanzania, which has partnered with the GFF since 2015, the government has more than doubled the percentage share of the government’s budget allocated to health, as mentioned above. The government is working with the GFF to tackle regional differences in health outcomes, including by channeling funding to frontline health care facilities to invest resources on community needs. Funding has also been provided to more than 5,800 health facilities to expand quality services, increase service utilization, reduce shortages of medicines and medical supplies, and to improve infrastructure. This work has contributed to maternal mortality rates declining by 82 percent and under-five mortality by 36 percent since 2015. There has also been progress across neonatal mortality, adolescent birth rate, and stunting among children under five years old — which have declined by 4 percent, 16 percent and 4 percent respectively since 2015.

In Nigeria, with the support of the GFF since 2015, the government has reformed policy and health financing strategies for delivering a package of services to the most vulnerable, conflict-affected communities and leading its expansion to 21 of the country’s 37 states between 2018 and 2021. The government is also improving the ability of primary health care facilities to operate effectively and with autonomy, track results, and promote accountability. This work has seen the out-of-pocket health spending decline from 69.2 percent in 2015, to 51.1 percent in 2020 (which is the most recent data). Between 2018 and 2021, under-five mortality has declined by 23 percent, neonatal mortality by 18 percent and the adolescent birth rate has declined by 29 percent.

In Kenya, which joined the GFF in 2015, the partnership is focused on improving the capacity and capability of local governments, through increasing budget allocation for health and shifting to a results-based model. The government is also strengthening engagement with the private sector to expand quality services to the most vulnerable communities and piloting the mobile civil registration units, as noted above. Between 2014 and 2022, under-five and infant mortality rates reduced by 21 percent and 18 percent respectively; the adolescent birth rate fell by 24 percent and under-five stunting by 31 percent.

Côte d’Ivoire has partnered with the GFF since 2017. This work has involved scaling up performance-based financing program, channeling more resources to community-level primary health facilities (public and private) and increasing service quality and equity. The GFF has also supported the rollout of the universal health coverage program—the Couverture Maladie Universelle — to provide equitable health coverage for women and children, including family planning. As a result of these interventions — in the ten years to 2021 maternal mortality rates have declined by 37 percent, and between 2016 and 2021 under-five mortality rate has declined by 23 percent, neonatal mortality has declined by 9 percent, and adolescent birth rate has declined by 23 percent.

 

[1] This analysis includes all GFF partner countries that have data from two surveys completed in the last ten years.

[2] Median Percentage Improvement between IC Baseline.

[3] Between 2016 and 2022, the median annual percent change in the number of women using modern contraceptives totaled 5.8 percent in GFF partner countries versus 4.3 percent in GFF-eligible countries. Similarly, the median annual percent change in the number of children who received three doses of DPT vaccine was 0.8 percent in GFF countries versus –0.3 percent in GFF-eligible countries. In GFF partner countries, the median percentage of IDA funding allocated to reproductive, maternal, newborn, child, and adolescent health and nutrition (RMNCAH-N) rose by 40 percent, which represents an increase of US$3.2 billion in new financing for women, children and adolescents. In contrast, the median percentage of IDA financing allocated to RMNCAH-N declined by 27 percent in the countries that are GFF-eligible, but not supported, over the same period.