Why is the GFF important for family planning?
As a multistakeholder, country-driven partnership and financing platform, the GFF could potentially provide additional funding for family planning. Every GFF-supported country develops an RMNCAH-N investment case, a three-to-five-year costed plan that prioritizes RMNCAH-N activities based on the country’s context and available funding. The investment cases lay out how GFF funding will be used in line with IDA/IBRD loans, other RMNCAH-N financing, and stakeholder agreements to implement high-impact, cost-effective activities that will contribute to lowering maternal and child mortality rates.
Family planning, as a high-impact, cost-effective intervention, is included in many countries’ investment cases; however, the degree of emphasis on family planning varies by country. As of March 2018, Cameroon,Democratic Republic of Congo,Ethiopia, Kenya, Liberia, Mozambique, Tanzania, and Uganda have publicly available investment cases. While all investment cases include family planning interventions and indicators, only Cameroon, Ethiopia, and Kenya have specified improved family planning outcomes as a development objective of GFF funding. Further, only a few countries include interventions to improve contraceptive procurement in their investment cases.
Kenya aims to increase long-acting family planning methods, particularly among youth, and permanent family planning methods for women who have finished childbearing. The GFF investment case highlights several immediate actions to reach these goals, including improving distribution of family planning commodities to increase access, scaling up youth-friendly health services, a voucher scheme to reach adolescents, and training pharmacy staff to provide family planning methods. The family planning activities are estimated to cost $US167 million over five years, 6 percent of the total cost of the investment case. The World Bank project appraisal document for GFF funding in Kenya includes funding for RMNCAH strategic commodities, especially family planning commodities.
Cameroon prioritizes family planning in its investment case. Cameroon’s goal is to increase the contraceptive prevalence rate for married women of reproductive age by at least 30 percent in four of 10 regions. The interventions include behavior change interventions, integration of family planning with other services, introduction of community-based delivery of injectables, and social marketing. Cameroon’s project appraisal document indicates that family planning will be included in the GFF-supported performance-based financing scheme through subsidies for new or existing family planning visits at the secondary care level. Overall, 16 percent of the US$82.4 million estimated cost is allocated for family planning interventions. Funding for contraceptive procurement is not included.
Even if family planning is prioritized in a RMNCAH-N investment case, it may not always translate into increased funding for family planning. GFF funding is more likely to succeed when the investment cases also incentivize (“crowd in”) additional funding commitments for family planning from other domestic and external sources. According to a review conducted by PAI, project appraisal documents (PADs) that describe activities being funded through GFF in each country are not necessarily aligned with the priority activities in the countries’ RMNCAH-N investment cases, even though a main goal of the investment case is to determine how GFF funding will be used. For example, the RMNCAH-N investment case for Tanzania includes objectives on family planning and contraceptive procurement, yet there is no mention of GFF funding for family planning or contraceptive procurement in the PAD. These misalignments suggest family planning may not receive direct support from the GFF and could remain underfunded in a country, even if it is prioritized in investment cases. However, broader health systems initiatives supported by GFF funding, such as results-based financing schemes, could include family planning. In this case, the activity would not be labeled or reported as a standalone family planning activity; it is thus unclear to what extent GFF funding will address family planning needs.
This document outlines Madagascar's experience in developing an investment case as part of a grant application for RMNCAH-N from the World
HP+ recently conducted a review of several countries' CIPs and GFF RMNCAH-N investment cases to examine how family planning priorities were
A 5-minute video about how the GFF is improving maternal and child health in Cameroon
A presentation by HP+ on best practices for developing an investment case for the GFF
A brief by PAI on how family planning is being prioritized in GFF investment cases and funding
A short article in the Lancet describing common misconceptions about the GFF
