Strengthening the Global Financing Architecture for Reproductive, Maternal, Newborn and Child Health (RMNCH)

Options for Action -- A report commissioned by PMNCH

Global  architecture report cover

10 NOVEMBER 2011 | GENEVA/WASHINGTON - Latest projections show that despite significant progress over the past decade, Millennium Development Goals 4 and 5 will not be reached. A new Report - Options for Action: Strengthening the Global Financing Architecture for RMNCH - commissioned by PMNCH and written by SEEK Development and the Global health Group examines options for improving aid architecture to optimally facilitate the mobilization and channeling of financing and the rapid scale-up of interventions for reproductive, maternal, newborn and child health (RMNCH). This report was presented to the PMNCH Board at its October meeting in Paris to stimulate discussion on financing for RMNCH.

Executive Summary

Although significant progress has been made in the last decade towards the health MDGs, MDGs 4 and 5 will not be reached according to the latest projections. One reason is that the current aid financing architecture for reproductive, maternal, newborn, and child health (RMNCH) may not be structured in a way that optimally facilitates the mobilization and channeling of financing and the rapid scale-up of RMNCH interventions. This report examines options for improving this aid architecture in order to accelerate progress towards MDGs 4 and 5.

Several initiatives have recently been launched aimed at addressing gaps and inefficiencies in the current aid architecture for RMNCH. These initiatives include the 2010 launch of the Global Strategy for Women’s and Children’s Health (Global Strategy). The Global Strategy and other recent efforts such as the International Health Partnership and the Health Systems Funding Platform are critically important, but they still leave weaknesses in the architecture, which could potentially delay the rapid implementation of the Global Strategy. Options for addressing these weaknesses, and thus strengthening the aid architecture, are therefore being considered by policymakers. Based on stakeholder interviews, a comprehensive literature review, and original analysis, this report suggests that there are three major options (two of which have “sub-options”) to address these remaining gaps. The options build on each other and were assessed along the dimensions of strategic fit, cost, impact, and feasibility.

OPTION 1 would involve strengthening the coordination and division of labor between major multilateral funding channels and bilateral programs. It would also entail enhancing the implementation architecture for the Global Strategy at the global and country level and fully leveraging the funding mandates of existing multilateral financers, such as the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund). A greater role for the United Nations Population Fund (UNFPA) and the United Nations Children’s Fund (UNICEF) in financing and/or procuring RMNCH drugs could also be considered. While this option would be feasible and relatively low cost, it is unlikely to bring the necessary urgency, new resources, and leadership required to get close to reaching MDGs 4 and 5.

OPTION 2 would start with strengthening coordination, fully leveraging existing funding mandates, and improving accountability, but would also add a targeted, rapid scale-up initiative focused on opportunities for quick impact. Option 2A would provide pooled donor funding, via a multi-donor trust fund (likely to be at the World Bank), for RMN CH-related elements of jointly assessed national health plans, initially for five countries that have these plans in place. This option could be quickly implemented with potential for substantial impact in these five countries, but it may be hard to rapidly roll out this approach in a larger number of countries. Option 2B would focus on scaling up coverage of selected high impact, low coverage interventions (management of childhood illnesses, skilled birth attendance, and family planning) in a subset of countries with the highest rates of maternal and child deaths (many of which are related to HIV/AIDS and malaria). Given the synergies of these interventions with current Global Fund investments, this initiative could be led by the Global Fund (but other mechanisms are also possible). This initiative could achieve even higher impact than Option 2A at similar cost. Under certain conditions, rapid roll out should be feasible.

OPTION 3 would go a step further still, creating a dedicated global funding channel. Option 3A would focus on a channel for RMNH only (with child health covered through existing financing arrangements). Option 3B proposes the creation of a fully integrated global funding channel for all health MDGs. The impact of both options on public health and aid effectiveness could eventually be very high. However, significant additional investments would be required, and feasibility of and political support for rapid implementation appear low at this time.