By Sarah Newey | The Telegraph | 6 November 2018
An innovative development fund that champions women and children has raised over US $1 billion to support health systems across the world.
At a conference in Oslo, co-hosted by the governments of Norway and Burkina Faso, 14 donors pledged hundreds of millions of dollars to enable the Global Financing Facility (GFF) to improve the lives of women in dozens of low and middle income countries.
The $1 billion, which includes £50 million (US$65) from the UK, takes the GFF halfway to its ultimate target of $2 billion - money it projects will save up to 35 million lives by 2030.
Set up in 2015 by the United Nations and World Bank, the GFF fund helps countries identify their priorities in improving the health of women and children and then brings together donors and the private sector to work with them.
The GFF is unique in that it puts women and children at the forefront of the investment agenda. In doing so, it has become perhaps the biggest feminist fund in the world – one that you’ve probably never heard of.
Another important feature of the fund is that it makes its grants strictly conditional on the receiving country pledging money and support of its own - a mechanism designed to ensure the investment becomes sustainable in the long term.
Each year, more than five million women and children still die from preventable conditions related to pregnancy, such as blood loss and infection, low birthweight and malnutrition.
“We have to have girls, women and children at the forefront of the agenda,” said Melinda Gates, co-chair of the Bill and Melinda Gates Foundation, pledging $200 million to the fund.
“When you invest in them, they invest in everybody else in their family, and life improves – not just in their family, but community by community and country by country.”
The fund's emphasis on building health systems – rather than focusing on specific issues such as providing antiretrovirals to treat HIV – marks a significant shift in international development funding.
“All our analysis means nothing unless there is a genuine trust in the country that it serves the interests of the people,” said Kristalina Georgieva, CEO of the World Bank. “We have seen success in development jump up dramatically when there is country led planning.”
When the world failed to meet the 2015 Millennium Development Goal targets to reduce child and maternal mortality, global aid models were criticised on both practical and ethical terms.
Countries became dependent on aid and vulnerable when money dried up, and investing in the fundamentals of a functioning health system was rarely prioritised, say critics.
More than 35 countries are set to lose official development assistance as they become wealthier and move from low to middle income country status. A model which encourages these "transitioning" countries to drive their own change will be fundamental to achieving the new Sustainable Development Goals by 2030.
At the replenishment conference in Oslo this week, “domestic resource mobilisation” were the buzz words.
But the focus on women and children is also critical.
“Health is not a burden on the country, it is an investment, which in the long run enables us to make economic growth and progress overall,” said Roch Marc Christian Kaboré, President of Burkina Faso.
“All the benefits that can be found in maternal and child health - they are the basis of growth, they are the basis of economic stability.”
Despite evidence that improving the health and education prospects of women, children and adolescents is the fastest way to lift a country out of poverty, these groups have historically been marginalised. For every 100 men in poverty worldwide, there are 122 women.
“I am a 28-year-old young African woman, but I am a grandmother,” Christina Clilimba, a youth expert who attended the conference from Malawi, told The Telegraph.
“My story is not uncommon, but it has driven me to advocate to allow young women to make the informed decisions.”
For women like Christina, the GFF represents new possibilities.
“I feel GFF will bring systems that were fragmented in the health system into one. The vision set out is the dream, it gives me hope because I can see how it would work on a grassroots level,” she said.
A GFF report earlier this year showed that in Democratic Republic of the Congo the number of births attended by a trained health worker increased by 15,000 during 2017 and 25,000 more children received their five routine vaccinations.
Similarly, Cameroon saw visits to family planning clinics in northern regions increase from less than 15,000 in the first quarter of 2017 to more than 25,000 in the fourth.
But while optimisism is widespread, some supporters remain cautious.
“Women’s health has been ignored in funding, particularly sexual reproductive health,” Katja Iversen, chief executive of global advocacy organisation Women Deliver, told The Telegraph.
“The GFF can be a really good vehicle to enhance funding, but it while it must be country-driven, it needs to make sure at a central level than women are always put at the centre. This is key.
“A health system that is ready to deliver when a woman is ready to deliver is a strong health system. A health system that doesn’t take into account a woman’s status in society will never be a strong health system. We can never ever forget that,” she added.