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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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Kiendrébéogo JA, Sory O, Kaboré I, Kafando Y, Kumar MB, George AS. Form and functioning: contextualising the start of the global financing facility policy processes in Burkina Faso. Glob Health Action 2024; 17:2360702. [PMID: 38910459 PMCID: PMC11198144 DOI: 10.1080/16549716.2024.2360702] [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: 09/20/2023] [Accepted: 05/23/2024] [Indexed: 06/25/2024] Open
Abstract
BACKGROUND Burkina Faso joined the Global Financing Facility for Women, Children and Adolescents (GFF) in 2017 to address persistent gaps in funding for reproductive, maternal, newborn, child, and adolescent health and nutrition (RMNCAH-N). Few empirical papers deal with how global funding mechanisms, and specifically GFF, support resource mobilisation for health nationally. OBJECTIVE This study describes the policy processes of developing the GFF planning documents (the Investment Case and Project Appraisal Document) in Burkina Faso. METHODS We conducted an exploratory qualitative policy analysis. Data collection included document review (N = 74) and in-depth semi-structured interviews (N = 23). Data were analysed based on the components of the health policy triangle. RESULTS There was strong national political support to RMNCAH-N interventions, and the process of drawing up the investment case (IC) and the project appraisal document was inclusive and multi-sectoral. Despite high-level policy commitments, subsequent implementation of the World Bank project, including the GFF contribution, was perceived by respondents as challenging, even after the project restructuring process occurred. These challenges were due to ongoing policy fragmentation for RMNCAH-N, navigation of differing procedures and perspectives between stakeholders in the setting up of the work, overcoming misunderstandings about the nature of the GFF, and weak institutional anchoring of the IC. Insecurity and political instability also contributed to observed delays and difficulties in implementing the commitments agreed upon. To tackle these issues, transformational and distributive leaderships should be promoted and made effective. CONCLUSIONS Few studies have examined national policy processes linked to the GFF or other global health initiatives. This kind of research is needed to better understand the range of challenges in aligning donor and national priorities encountered across diverse health systems contexts. This study may stimulate others to ensure that the GFF and other global health initiatives respond to local needs and policy environments for better implementation.
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Affiliation(s)
- Joël Arthur Kiendrébéogo
- Department of Public Health, University Joseph Ki-Zerbo, Ouagadougou, Burkina Faso
- Department of Research, Expertise and Capacity Building, 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
| | - Orokia Sory
- Department of Research, Expertise and Capacity Building, Recherche pour la santé et le développement (RESADE), Ouagadougou, Burkina Faso
| | - Issa Kaboré
- Operations Division, Recherche pour la santé et le développement (RESADE), Ouagadougou, Burkina Faso
| | - Yamba Kafando
- Operations Division, Recherche pour la santé et le développement (RESADE), Ouagadougou, Burkina Faso
| | - Meghan Bruce Kumar
- London School of Hygiene and Tropical Medicine, Faculty of Public Health and Policy, London, UK
- Department of Health Systems and Research Ethics, KEMRI-Wellcome Trust Programme, Nairobi, Kenya
- Northumbria University, Department of Nursing, Midwifery and Health, Newcastle upon Tyne, UK
| | - Asha S. George
- School of Public Health, University of the Western Cape, Cape Town, South Africa
- Health Systems Extra-Mural Unit, South African Medical Research Council, 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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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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Carnahan E, Gurley N, Asiimwe G, Chilundo B, Duber HC, Faye A, Kamya C, Mpanya G, Nagasha S, Phillips D, Salisbury N, Shearer J, Shelley K. Lessons Learned From Implementing Prospective, Multicountry Mixed-Methods Evaluations for Gavi and the Global Fund. GLOBAL HEALTH: SCIENCE AND PRACTICE 2020; 8:771-782. [PMID: 33361241 PMCID: PMC7784079 DOI: 10.9745/ghsp-d-20-00126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 09/30/2020] [Indexed: 11/24/2022]
Abstract
Lessons learned from implementing evaluations for Gavi, the Vaccine Alliance and the Global Fund for AIDS, Tuberculosis, and Malaria can help inform the design and implementation of ongoing or future evaluations of complex interventions. We share 5 lessons distilled from over 7 years of experience implementing evaluations in 7 countries. Introduction: As global health programs have become increasingly complex, corresponding evaluations must be designed to assess the full complexity of these programs. Gavi and the Global Fund have commissioned 2 such evaluations to assess the full spectrum of their investments using a prospective mixed-methods approach. We aim to describe lessons learned from implementing these evaluations. Methods: This article presents a synthesis of lessons learned based on the Gavi and Global Fund prospective mixed-methods evaluations, with each evaluation considered a case study. The lessons are based on the evaluation team’s experience from over 7 years (2013–2020) implementing these evaluations. The Centers for Disease Control and Prevention Framework for Evaluation in Public Health was used to ground the identification of lessons learned. Results: We identified 5 lessons learned that build on existing evaluation best practices and include a mix of practical and conceptual considerations. The lessons cover the importance of (1) including an inception phase to engage stakeholders and inform a relevant, useful evaluation design; (2) aligning on the degree to which the evaluation is embedded in the program implementation; (3) monitoring programmatic, organizational, or contextual changes and adapting the evaluation accordingly; (4) hiring evaluators with mixed-methods expertise and using tools and approaches that facilitate mixing methods; and (5) contextualizing recommendations and clearly communicating their underlying strength of evidence. Conclusion: Global health initiatives, particularly those leveraging complex interventions, should consider embedding evaluations to understand how and why the programs are working. These initiatives can learn from the lessons presented here to inform the design and implementation of such evaluations.
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Affiliation(s)
| | | | | | | | - Herbert C Duber
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.,Department of Emergency Medicine, University of Washington, Seattle, WA, USA
| | - Adama Faye
- Institut de Santé et Développement/University Cheikh Anta Diop, Dakar, Senegal
| | - Carol Kamya
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | | | | | - David Phillips
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
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