Wemos Dr Lisa Seidelmann GFF Spring Meetings 2019 Civil Society Policy Forum

After the replenishment: How is the Global Financing Facility addressing civil society’s concerns?

Myria Koutsoumpa & Lisa Seidelmann

Is the Global Financing Facility (GFF) addressing civil society’s critical concerns after the replenishment in November? Wemos sought an answer to this question at our fruitful session in April at the Civil Society Policy Forum, at the 2019 Spring Meetings of the World Bank and the International Monetary Fund (IMF) in Washington D.C.

With almost 50 attendees, and co-organised by Wemos, Médecins Sans Frontières (MSF), Oxfam UK and Cehurd-Uganda, there was ample time and room for discussions at our session, which was moderated by our global health advocate Dr Lisa Seidelmann. In November 2018, we expressed our concerns about the GFF approach in an open letter to the organisation, endorsed by over 50 civil society organisations. In this letter we called on the GFF to take action on issues like civil society engagement, health workforce crisis, the GFF’s financial model, and financial barriers to healthcare access. To discuss this with the GFF and World Bank representatives in the very heart of the international financial institutions was therefore a perfect opportunity.


A case of ‘learning by doing’

Dr Monique Vledder (Practice Manager at the GFF) and Michele Gragnolati (Practice Manager for Strategy, Health, Nutrition and Population at the World Bank) joined our panel, together with Dr Mit Philips (MSF) and Moses Mulumba (Cehurd-Uganda). Mulumba shared his experience from Uganda’s conceptualization of the GFF programme, in which civil society was largely not involved. He stated that ‘civil society was still absent in the Ugandan Country Platform.’ Admitting that Uganda was a case of “learning by doing” for the GFF, Vledder said that the GFF aims to address the challenges regarding civil society involvement and information flow by introducing a new position, liaison officers, who will support the information flow between all parties. She also referred to the importance of a functioning Country Platform for the success of the GFF approach in the countries. In fact, the GFF is now explicitly looking for governments that are committed to an inclusive country platform with active civil society participation, to be included in the new round of GFF programmes. However, she also pointed out that there is no space for civil society representation in the Trust Fund Committee. To address this exclusive governance model, the GFF is interested in strengthening the link between the Trust Fund Committee and the Investor’s Group by improving the transparency of the Trust Fund Committee’s work and meetings.


Health workers: to pay or not to pay

The panel also discussed the global health workforce crisis. Philips pointed out that paying frontline workers and creating jobs should be in the priorities of the GFF if we want to achieve Universal Health Coverage. While acknowledging the importance of a solid health workforce, Vledder highlighted that we need to be country-specific in our actions, and should –  apart from remuneration –also tackle inefficiency, ‘ghost workers’ and absenteeism. From the World Bank’s side, Gragnolati was very straightforward, i.e. the World Bank does not anticipate changing its current practice of not funding health workers’ salaries due to sustainability concerns.


Regarding financial barriers to access to health care, we were happy that Gragnolati mentioned that the World Bank does not promote user fees anymore, as they affect people’s chances of becoming impoverished. ‘For the World Bank, financial protection is core element and always thought along.’


Private sector in health care: is it under control?

According to Vledder, the main reason for involving the private sector in healthcare is to improve efficiency. According to the other panelists, it’s still important to keep this engagement in check. For example, Gragnolati highlighted that it’s important to improve regulation for the private sector to offer better access to health services to more people. Mulumba drew attention to the fact that in Uganda, the private for-profit sector has increased by 500% in the last decade – 10 times more than the public sector, while most of the population still seeks care in the public sector. According to Philips, we must consistently assess the risks and benefits of private sector engagement to prevent negative impacts on population health.


Regarding International Development Assistance (IDA) loans, Gragnolati mentioned the IDA envelope is not increased by the GFF loan that countries take out. This means that it would not lead to increased indebtedness, as countries can decide together with the World Bank which sector they want to allocate this money to.


Keeping the dialogue open

Overall, we had a friendly and open discussion with the GFF and the World Bank, and felt that our concerns were taken seriously. Vledder acknowledged some of the issues raised as continued problems that the GFF was aware of and tried to come by, such as better inclusiveness of civil society in the country platforms or the need to properly staff health care providers to deliver a minimum benefit package to all women, children, and adolescents. However, the GFF and World Bank are clearly not up for a change regarding other critical concerns that we mentioned in our letter, like the exclusive governance model in the Trust Fund Committee or funding health worker salaries to achieve sufficient staff at health facilities. Regarding other areas like the private sector, they did not commit to putting in place a framework as was suggested in the letter to consistently monitor the engagement of the private sector and its consequences for the population.


We will stay put to continue discussions with the GFF and the World Bank in order to achieve the best possible GFF that will end preventable deaths of women, children and adolescents and improve their health and well-being.



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