The GFF: Budding with potential, yet to bloom.

By James Sale, Health & Finance Policy Advisor, Save the Children

April in D.C. pretty much means Cherry Blossom season, but for a few thousand of government, civil society, business, and multilateral workers it also means the World Bank Spring Meetings. There is so much happening on the, what feels like, hundreds of agendas, that coupled with the jet lag, I still find this global gathering overwhelming. So, I have to stick to my agenda which this year is the Global Financing Facility or to everyone here ‘the GFF’.

It’s a big year for the GFF with their first replenishment and an ambitious target of $2 billon. Today, and with the replenish year in full swing, Save the Children has launched a briefing outlining what we think is good about and what can be improved by the GFF to turn it into the pioneering development financing model it has the potential to be. The focus on countries generating their own finance to fund health systems, the approach of countries deciding what their health systems need and the push to find more innovative finance opportunities to fill the annual $33.3 billion gap in health services for women and child, are refreshing and to be applauded.

The GFF also has natural synergies with UHC and in many countries it can play a key role in establishing financial structures that will enable UHC. However, it is important that the GFF is not seen as the financial solution to UHC or the “UHC fund,” as the UHC financing gap is much larger than the amount the GFF will be able to help mobilise before 2030. That gap will only be filled by substantially increased domestic resources, supported by bilateral and multi-lateral donors and mechanisms.

The replenishment year provides an exciting opportunity for donors to shape the future of this potentially trend-setting mechanism. The health finance community is keenly watching the GFF to see how this new and more diverse approach works; is this the model that will be adopted by other sectors and other global funds to break the aid paradigm? It may be a GFF 2.0 or 3.0 that has the breakthrough success, but there is a good chance that the genesis will be here. If this is the case then it is crucial that forward thinking, experienced and influential donor governments such as European Union, Germany, Japan, Norway, and the UK, to name just a handful, fully engage with the GFF. In the current development finance environment, influential donor engagement comes through financial support.

However, it is early days and the GFF’s proposed new model and the optimism surrounding it needs to be continually tested and proven. Unless the GFF genuinely delivers on its transformational ambitions, it could simply become another traditional financing mechanism, cementing the existing development paradigm, and increasing aid dependency and indebtedness. Save the Children has identified four key areas that the GFF needs to address, and soon.

The four things that the GFF needs to do to make it a success:

1. The GFF must be genuinely transformational in assisting governments to develop effective and holistic approaches to generating increased and sustainable domestic resources for health systems, underpinned by accountable health financing strategies, and fully costed national health and nutrition plans

2. The GFF must protect recipient countries from bad or unsustainable debt through diligent use of indebtedness protection controls, and employ additional controls and caution for private sector finance

3. The GFF must continue to ensure that the services and activities it supports promote universal access to the comprehensive sexual, reproductive, maternal, neonatal, child, adolescent health and nutrition ‘continuum of care’ principally through primary healthcare

4. The GFF needs to allow civil society to play a full and effective accountability role by increasing transparency, access, and financial support to civil society at all levels.

To find out more about our thinking and the 24 specific recommendations behind these four see our policy briefing.

The GFF is not there yet and there is a way to go, but the intent and transformational ambitions need to be nurtured and supported by all now.