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Walmisley U, Kinney MV, Kiendrébéogo JA, Kafando Y, George AS. Any better? A follow-up content analysis of adolescent sexual and reproductive health inclusion in Global Financing Facility country planning documents. Glob Health Action 2024; 17:2315644. [PMID: 38962875 PMCID: PMC11188955 DOI: 10.1080/16549716.2024.2315644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 02/03/2024] [Indexed: 07/05/2024] Open
Abstract
BACKGROUND The Global Financing Facility (GFF) supports national reproductive, maternal, newborn, child, adolescent health, and nutrition needs. Previous analysis examined how adolescent sexual and reproductive health was represented in GFF national planning documents for 11 GFF partner countries. OBJECTIVES This paper furthers that analysis for 16 GFF partner countries as part of a Special Series. METHODS Content analysis was conducted on publicly available GFF planning documents for Afghanistan, Burkina Faso, Cambodia, CAR, Côte d'Ivoire, Guinea, Haiti, Indonesia, Madagascar, Malawi, Mali, Rwanda, Senegal, Sierra Leone, Tajikistan, Vietnam. Analysis considered adolescent health content (mindset), indicators (measure) and funding (money) relative to adolescent sexual and reproductive health needs, using a tracer indicator. RESULTS Countries with higher rates of adolescent pregnancy had more content relating to adolescent reproductive health, with exceptions in fragile contexts. Investment cases had more adolescent content than project appraisal documents. Content gradually weakened from mindset to measures to money. Related conditions, such as fistula, abortion, and mental health, were insufficiently addressed. Documents from Burkina Faso and Malawi demonstrated it is possible to include adolescent programming even within a context of shifting or selective priorities. CONCLUSION Tracing prioritisation and translation of commitments into plans provides a foundation for discussing global funding for adolescents. We highlight positive aspects of programming and areas for strengthening and suggest broadening the perspective of adolescent health beyond the reproductive health to encompass issues, such as mental health. This paper forms part of a growing body of accountability literature, supporting advocacy work for adolescent programming and funding.
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Affiliation(s)
- Ulla Walmisley
- School of Public Health, University of the Western Cape, Cape Town, South Africa
| | - Mary V. Kinney
- School of Public Health, University of the Western Cape, Cape Town, South Africa
| | - Joël Arthur Kiendrébéogo
- Department of Public Health, University Joseph Ki-Zerbo, Ouagadougou, Burkina Faso
- Recherche pour la Santé et le Développement (RESADE), Ouagadougou, Burkina Faso
- Heidelberg Institute of Global Health, Medical Faculty and University Hospital, Heidelberg University, Heidelberg, Germany
- Institute of Tropical Medicine, Department of Public Health, Antwerp, Belgium
| | - Yamba Kafando
- Recherche pour la Santé et le Développement (RESADE), Ouagadougou, Burkina Faso
| | - Asha S. George
- School of Public Health, University of the Western Cape, Cape Town, South Africa
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Kinney M, Kumar MB, Kaboré I, Kiendrébéogo J, Waiswa P, Lawn JE. Global Financing Facility investments for vulnerable populations: content analysis regarding maternal and newborn health and stillbirths in 11 African countries, 2015 to 2019. Glob Health Action 2024; 17:2329369. [PMID: 38967540 PMCID: PMC11229757 DOI: 10.1080/16549716.2024.2329369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 03/07/2024] [Indexed: 07/06/2024] Open
Abstract
BACKGROUND The Global Financing Facility (GFF) was launched in 2015 to catalyse increased domestic and external financing for reproductive, maternal, newborn, child, adolescent health, and nutrition. Half of the deaths along this continuum are neonatal deaths, stillbirths or maternal deaths; yet these topics receive the least aid financing across the continuum. OBJECTIVES To conduct a policy content analysis of maternal and newborn health (MNH), including stillbirths, in GFF country planning documents, and assess the mortality burden related to the investment. METHODS Content analysis was conducted on 24 GFF policy documents, investment cases and project appraisal documents (PADs), from 11 African countries. We used a systematic data extraction approach and applied a framework for analysis considering mindset, measures, and money for MNH interventions and mentions of mortality outcomes. We compared PAD investments to MNH-related deaths by country. RESULTS For these 11 countries, USD$1,894 million of new funds were allocated through the PADs, including USD$303 million (16%) from GFF. All documents had strong content on MNH, with particular focus on pregnancy and childbirth interventions. The investment cases commonly included comprehensive results frameworks, and PADs generally had less technical content and fewer indicators. Mortality outcomes were mentioned, especially for maternal. Stillbirths were rarely included as targets. Countries had differing approaches to funding descriptions. PAD allocations are commensurate with the burden. CONCLUSIONS The GFF country plans present a promising start in addressing MNH. Emphasising links between investments and burden, explicitly including stillbirth, and highlighting high-impact packages, as appropriate, could potentially increase impact.
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Affiliation(s)
- Mary Kinney
- School of Public Health, University of the Western Cape, Cape Town, South Africa
| | - Meghan Bruce Kumar
- Department of Nursing, Midwifery and Health, Nothumbria University, Newcastle upon Tyne, UK
- Health Systems and Research Ethics, KEMRI-Wellcome Trust Programme, Nairobi, Kenya
| | - Issa Kaboré
- Operations Division, Research, Expertise and Training Department, Recherche Pour la Santé et le Développement (RESADE, Ouagadougou, Burkina Faso
| | - Joël Kiendrébéogo
- Department of Research, Expertise and Capacity Building, Research, Expertise and Training Department, Recherche Pour la Santé et le Développement (RESADE), Ouagadougou, Burkina Faso
- Department of Public Health, University Joseph Ki-Zerbo, Ouagadougou, Burkina Faso
- Heidelberg Institute of Global Health, Medical Faculty and University Hospital, Heidelberg University, Heidelberg, Germany
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Peter Waiswa
- School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Joy E. Lawn
- Department of Infectious Disease Epidemiology and International Health, London School of Hygiene & Tropical Medicine, London, UK
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Gupta S, PN Rao S, Yoshida S, Bahl R. Global newborn health research priorities identified in 2014: A review to evaluate the uptake. EClinicalMedicine 2022; 52:101599. [PMID: 35958522 PMCID: PMC9358417 DOI: 10.1016/j.eclinm.2022.101599] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 07/14/2022] [Accepted: 07/14/2022] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND In 2014, World Health Organization published global research priorities for newborn health till 2025. We conducted this review to summarize completed or ongoing research on the twenty priorities. METHODS We conducted searches for twenty questions on MEDLINE via PubMed, Cochrane CENTRAL, Web of Science, clinical trial registries, and funder websites between July 2014 and May 2022. Studies addressing research questions using adequate design were included. Adequacy of uptake of a priority was assessed based on predefined criteria. FINDINGS The uptake of research priorities was high for 8 (40%), moderate for 11 (55%), and one priority, effectiveness of training community health workers (CHWs) to treat neonatal sepsis at home remains unaddressed. Priorities with moderate uptake include effectiveness of simplified neonatal resuscitation programme, simple clinical algorithms for CHWs to neonatal infection, CHWs training in basic neonatal resuscitation, community-initiated kangaroo mother care, perinatal audits, and novel tocolytic agents, scaling-up chlorhexidine cord application, stable surfactant with simpler administration, accurate, affordable methods to diagnose fetal distress, strategies for prevention and treatment of intrauterine growth retardation, and causal pathways for antenatal stillbirths. INTERPRETATION Adequate research was undertaken on pressing global concerns in newborn health. Funders and researchers should reflect on and address less researched areas. FUNDING None.
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Affiliation(s)
| | | | | | - Rajiv Bahl
- Corresponding author at: Newborn Unit Head, Department of Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, 20 Avenue Appia, CH-1211, Geneva, Switzerland.
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George AS, Jacobs T, Kinney MV, Haakenstad A, Singh NS, Rasanathan K, Chopra M. Are rhetorical commitments to adolescents reflected in planning documents? An exploratory content analysis of adolescent sexual and reproductive health in Global Financing Facility country plans. Reprod Health 2021; 18:124. [PMID: 34134726 PMCID: PMC8210342 DOI: 10.1186/s12978-021-01121-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 03/11/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND The Global Financing Facility (GFF) offers an opportunity to close the financing gap that holds back gains in women, children's and adolescent health. However, very little work exists examining GFF practice, particularly for adolescent health. As momentum builds for the GFF, we examine initial GFF planning documents to inform future national and multi-lateral efforts to advance adolescent sexual and reproductive health. METHODS We undertook a content analysis of the first 11 GFF Investment Cases and Project Appraisal Documents available on the GFF website. The countries involved include Bangladesh, Cameroon, Democratic Republic of Congo, Ethiopia, Guatemala, Kenya, Liberia, Mozambique, Nigeria, Tanzania and Uganda. RESULTS While several country documents signal understanding and investment in adolescents as a strategic area, this is not consistent across all countries, nor between Investment Cases and Project Appraisal Documents. In both types of documents commitments weaken as one moves from programming content to indicators to investment. Important contributions include how teenage pregnancy is a universal concern, how adolescent and youth friendly health services and school-based programs are supported in several country documents, how gender is noted as a key social determinant critical for mainstreaming across the health system, alongside the importance of multi-sectoral collaboration, and the acknowledgement of adolescent rights. Weaknesses include the lack of comprehensive analysis of adolescent health needs, inconsistent investments in adolescent friendly health services and school based programs, missed opportunities in not supporting multi-component and multi-level initiatives to change gender norms involving adolescent boys in addition to adolescent girls, and neglect of governance approaches to broker effective multi-sectoral collaboration, community engagement and adolescent involvement. CONCLUSION There are important examples of how the GFF supports adolescents and their sexual and reproductive health. However, more can be done. While building on service delivery approaches more consistently, it must also fund initiatives that address the main social and systems drivers of adolescent health. This requires capacity building for the technical aspects of adolescent health, but also engaging politically to ensure that the right actors are convened to prioritize adolescent health in country plans and to ensure accountability in the GFF process itself.
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Affiliation(s)
- Asha S George
- School of Public Health, University of the Western Cape, Bellville, Private Bag x17, Cape Town, 7535, South Africa.
| | - Tanya Jacobs
- School of Public Health, University of the Western Cape, Bellville, Private Bag x17, Cape Town, 7535, South Africa
| | - Mary V Kinney
- School of Public Health, University of the Western Cape, Bellville, Private Bag x17, Cape Town, 7535, South Africa
| | - Annie Haakenstad
- Department of Global Health and Population, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA
| | - Neha S Singh
- Department of Global Health and Development, London School of Tropical Hygiene and Medicine, London, WC1E 7HT, UK
| | | | - Mickey Chopra
- World Bank, 1818 H Street, NW, Washington, DC, 20433, USA
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Kumar MB, Taegtmeyer M, Madan J, Ndima S, Chikaphupha K, Kea A, Barasa E. How do decision-makers use evidence in community health policy and financing decisions? A qualitative study and conceptual framework in four African countries. Health Policy Plan 2020; 35:799-809. [PMID: 32516361 PMCID: PMC7487332 DOI: 10.1093/heapol/czaa027] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2020] [Indexed: 11/29/2022] Open
Abstract
Various investments could help countries deliver on the universal health coverage (UHC) goals set by the global community; community health is a pillar of many national strategies towards UHC. Yet despite resource mobilization towards this end, little is known about the potential costs and value of these investments, as well as how evidence on the same would be used in related decisions. This qualitative study was conducted to understand the use of evidence in policy and financing decisions for large-scale community health programmes in low- and middle-income countries. Through key informant interviews with 43 respondents in countries with community health embedded in national UHC strategies (Ethiopia, Kenya, Malawi, Mozambique) and at global institutions, we investigated evidence use in community health financing and policy decision-making, as well as evidentiary needs related to community health data for decision-making. We found that evidence use is limited at all levels, in part due to a perceived lack of high-quality, relevant evidence. This perception stems from two main areas: first, desire for local evidence that reflects the context, and second, much existing economic evidence does not deal with what decision-makers value when it comes to community health systems-i.e. coverage and (to a lesser extent) quality. Beyond the evidence gap, there is limited capacity to assess and use the evidence. Elected officials also face political challenges to disinvestment as well as structural obstacles to evidence use, including the outsized influence of donor priorities. Evaluation data must to speak to decision-maker interests and constraints more directly, alongside financiers of community health providing explicit guidance and support on the role of evidence use in decision-making, empowering national decision-makers. Improved data quality, increased relevance of evidence and capacity for evidence use can drive improved efficiency of financing and evidence-based policymaking.
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Affiliation(s)
- Meghan Bruce Kumar
- Community Health Systems Group, Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
- MARCH Centre, London School of Hygiene and Tropical Medicine, London, UK
| | - Miriam Taegtmeyer
- Community Health Systems Group, Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
- Tropical Infectious Disease Unit, Royal Liverpool University Hospital, Liverpool, UK
| | - Jason Madan
- Centre for Health Economics at Warwick, Warwick Medical School, University of Warwick, Coventry, UK
| | - Sozinho Ndima
- Community Health Department, Faculty of Medicine, University Eduardo Mondlane, Maputo, Mozambique
| | | | - Aschenaki Kea
- School of Public and Environmental Health, Hawassa University, Hawassa, Ethiopia
- Center for International Health, University of Bergen, Bergen, Norway
| | - Edwine Barasa
- Health Economics Research Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
- Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
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Friebel R, Silverman R, Glassman A, Chalkidou K. On results reporting and evidentiary standards: spotlight on the Global Fund. Lancet 2019; 393:2006-2008. [PMID: 30691700 DOI: 10.1016/s0140-6736(18)33055-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 10/29/2018] [Accepted: 11/23/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Rocco Friebel
- Department of Health Policy, The London School of Economics and Political Science, London, UK; Center for Global Development, Washington, DC, USA.
| | | | | | - Kalipso Chalkidou
- Center for Global Development, Washington, DC, USA; School of Public Health, Imperial College London, London, UK
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Salisbury NA, Asiimwe G, Waiswa P, Latimer A. Operationalising the Global Financing Facility (GFF) model: the devil is in the detail. BMJ Glob Health 2019; 4:e001369. [PMID: 30997172 PMCID: PMC6441293 DOI: 10.1136/bmjgh-2018-001369] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 01/14/2019] [Accepted: 01/19/2019] [Indexed: 11/05/2022] Open
Affiliation(s)
| | | | - Peter Waiswa
- School of Public Health, Makerere University, Kampala, Uganda
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Davis A, Walker DG. On the Path to UHC - Global Evidence Must Go Local to Be Useful Comment on "Disease Control Priorities Third Edition Is Published: A Theory of Change Is Needed for Translating Evidence to Health Policy". Int J Health Policy Manag 2019; 8:181-183. [PMID: 30980635 PMCID: PMC6462195 DOI: 10.15171/ijhpm.2018.118] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 11/24/2018] [Indexed: 11/30/2022] Open
Abstract
The Disease Control Priorities (DCP) publications have pioneered new ways of thinking about investing in health. We agree with Norheim, that a useful first step to advance efforts to translate DCP's global evidence into local health priorities, is to develop a clear Theory of Change (ToC). However, a ToC that aims to define how global evidence (DCP and others) can be used to inform national policy is too narrow an undertaking. We propose efforts should be directed towards developing a ToC to define how to support progressive institutional development to deliver on universal health coverage (UHC), putting the client at the center. Enhancing efforts to meet the new global health imperatives requires a shift in focus of attention to move radically from global to local. In order to achieve this we need to reorganize the nature of technical assistance (TA) along three major lines (1) examine and act to clarify the mandates and roles to be played by multilateral normative and convening agencies, (2) ensure detailed understanding of local institutions, their needs and their demands, and (3) provide TA over time and in trust with local counterparts. This last requirement implies the need for long-term local presence as well as an international network of expertise centers, to share scarce technical capabilities as well as to learn together across country engagements. Financing will need to be reorganized to incentivize and support demand-led capacity strengthening.
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Affiliation(s)
- Austen Davis
- Norwegian Agency for Development Cooperation (Norad), Oslo, Norway
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