Global Health Initiatives Civil Society Organization support

1. Global Health InitiativesCivil Society Organization support May 2018

2. Contents • Project overview • Analysis approach • Phase I analysis | Overview of grants • Phase II analysis | Country “deep dive”: Kenya • Recommendations • Phase III pilot | Proposed country: Côte d’Ivoire

3. Project overview GOAL • Harmonize efforts in support of civil society organizations leading advocacy, policy and accountability for better health outcomes and achievement of UHC Goal and context You are here Recommendations for greater alignment Review of existing grant mechanisms Consultationon preliminary findings A B C D Overview of Global Health Initiatives support to CSOs

4. Project overview: Proposed approach • Identification of focal points in Gavi, GFF, GFATM, SUN, PMNCH through PMNCH GHIs constituency • Scope current and future support to civil society organizations by the major GHIs on advocacy and accountability through survey feedback and ITW • Identify common objectives, activities and priority countries • Map current gaps in supporting CSOs and outline challenges in aligning support and advocacy efforts • Enhance discussion with GHIs focal points and CSO constituencies to review analysis and develop recommendations • Draft recommendations to share with various boards and CSO constituencies

5. GHIs support to CSOs– Volume and focus Total CSOs support per year: $15,615m Strengthening of national coalitions, TA and capacity building

6. Project overview | GHI priorities Type of support Expected outcomes Participation of CSOs in the governance of the GHI/partnership Participation in policy design at the country level Policy prioritization of the mandate of the GHI/partnership Resource mobilization Accountability of national, regional & global commitments CSOs access funding at the country level for operations The following Support Types and Expected Outcomes are proposed criteria to guide improved coordination among supported CSOs • Global/Regional constituency coordination • Creation and/or strengthening national platforms or coalitions • Technical assistance and capacity building • Support for meetings, workshops and international conferences

7. Phase I Analysis Overview of Grants* # grants *limited to the 88 grants included in anlaysis

8. Phase I | About the analysis Purpose and objectives • Landscape GHI support to CSOs • ID areas of overlap, opportunities for coordination across: • Geography • Issue areas • Activities • Stakeholders • Inform strategizing among GHI focal points towards streamlining strategy • Methodology • Develop categories for analyzing grants • Administrative: Name, donor, geography, funding amount, grant start/end dates • Descriptive: issue areas, support types, activity levels, target populations, target audiences • Review 88 GHI-funded grants • Donors: FP2020, Gavi, PMNCH (GFF), GFATM, PMNCH-WD (Youth), SUN • Materials: Narrative proposals, agreements and contracts, interim & final reports

9. CSO support | Summary overview

10. Summary findings | Leading features (1/2) Note that findings reflect significant discrepancies in # grants funded from one GHI to the next Issue area Activity type Note: Not all descriptors are included here; these represent the top 6 characteristics in each descriptive category

11. Summary findings | Leading features (2/2) Note that findings reflect significant discrepancies in # grants funded from one GHI to the next Target audience Target population Note: Not all descriptors are included here; these represent the top 6 characteristics in each descriptive category

12. Phase II Analysis Country Deep Dive Kenya

13. Phase II | Country “Deep Dive” • Preliminary analysis enables in-depth look at high-engagement countries • Sufficient data is available to provide rich profile of GHI-supported CSO landscape • Profile issue area, activities, target population, etc. • Kenya was selected for Phase II analysis, because: • Only country with all GHIs present • Among highest volume of grants overall (n=10)

14. CSO landscape: Summary common features • Issue areas: • Nutrition • Sexual and reproductive health • Tuberculosis • Activity types: • Convenings and workshops • Policy advocacy • Capacity building (advocacy, demand generation, stakeholder engagement) • Target populations: • Marginalized populations • Adolescent health • Child health • Target audiences: • NGO / CSO • Community members • Health workers • Local government CSO names forthcoming

15. CSO landscape: Summary gaps • Non-focus issue areas: • Education • Quality of care • Non-prioritized activities: • Resource mobilization • Budget advocacy • Research and anlaysis • Non-target populations: • Maternal health • Newborn health • Non-target audiences: • Private Sector • Media • Ministry of Finance • Academia CSO names forthcoming

16. GHI alignment | Type of support

17. GHI alignment | Expected outcomes

18. Kenya CSO approach | Key considerations Strengths and potential overlap Opportunities Improved coordination, whether sub-nationally or regionally, is a missed opportunity among these CSOs; it can be assumed to a degree that these CSOs are aware of one another (and collaborate informally), but CSOs are not incentivized to collaborate or coordinate resources given the structure of donor support Many priority GHI activities and outcomes are not being supported by CSOs in Kenya; there are opportunities in: Supporting CSOs capacity for budget and resource mobilization advocacy (both for intended populations and their own operations); and Incentivizing CSOs to proactively coordinate efforts and collaborate on addressing common challenges • High priority and overlapping issue areas include TB, HIV and related supportive efforts including SRHR, nutrition, education, and strengthening community level response • However, a richer idea of the sub-national geographic spread and overlap of engagement will help determine where efforts are concentrated, and where there is possibility to achieve gains through increased distribution of funding • Technical assistance, capacity building, and convenings are activities being implemented by almost all CSOs funded by GHIs; these activities are central to all efforts and related funding should remain (or increase), and explore opportunities for alignment

19. Recommendations • The richest data and expertise will come through consultations with CSOs (in country) themselves! This analysis draws on data that is often limited and inconsistent; consultation with in-country partners will provide a better understanding of: • Context and challenges related to specific issue areas • Sub-national geographic spread of CSO activities • Existing collaboration/coordination that is not reflected in grant documents • “Coordination and cooperation” must be a clear expectation for CSOs, who may be competing for funding • GHI-supported CSOs can be approached with the broad expectation that re-alignment of efforts, and improved coordination in certain areas, can benefit the collective GHI goals • GHI donors must allocate funding for coordination and cooperation, and to collectively support broad health financing advocacy and to coordination and cooperation (in addition to “issue specific” advocacy) • Recognizing that each CSO has a unique value-add, there may be value in aligning those more precisely with known gaps or challenges • Explore pilot opportunities in select countries for aligned funding around common activities and priorities, i.e.: health financing & budget advocacy Considerations looking ahead

20. Phase III Pilot Proposed country: Côte d’Ivoire

21. Côte d’Ivoire – Context • National commitment to reach UHC • Goal : Scale up a compulsory public health insurance scheme to reach 100 % coverage • National Health Financing Dialogue supported by the GFTAM • Goal : Develop a national road map for increased domestic resources for health • GFF investment case development : • Goal : Increase domestic and ensure more sustainable financing for RMNCA-H • Côte d’Ivoire entering Gavi accelerated transition in 2020 • Goal: Reach 100 % vaccines procurement and full sustainability of Gavi supported programmes by 2025

22. Côte d’Ivoire – Opportunities for joint CSO engagement • Actions to date • Discussion with GFATM, GFF and the French MFA on aligning process at the country level with the aim of creating one health financing high level moment in Q3/Q4 2018 • CSO Health financing advocacy workshop on the 20th, 21st and 22nd of June in Abidjan led by Asapsu with wide constituency representation • Next steps and opportunities for engagement: • Advocate for a formal agreement between Côte d’Ivoire, the GFF, GFATM, Gavi to organise a high level financing event in Q3/Q4 2018 • Organise a Civil society consultation in advance of the high level financing event by end of September • Support partners in organising an MP engagement track by October Creating a joint CSO led campaign on health financing towards UHC ?

23. Appendix Descriptive analysis

24. GHI donor engagement

25. Active CSOs / grantees

26. Profile: Issue Area Priority issue areas in Kenya not reported or not a focus: Gender, Malaria, Human Rights, Health System Governance, Information Systems, Financing, Human Resources, Pneumonia, Vaccines

27. Summary observations: Issue Area • Strengths: • Nutrition • Sexual and reproductive health • Tuberculosis • Gaps: • Education • Quality of care • Questions for discussion • Which of these results a) align with, or b) deviate from GHI priorities, strategy, expectations in Kenya? • Which of the issue areas require additional attention, funding and coordination among the GHIs • Next steps: • Examine in further detail the categories that exhibit overlap (e.g., TB / Service Delivery) to understand the fuller spectrum of strategy and activities supported by the GHIs

28. Profile: Grantee Activity Type and Expertise

29. Summary observations: Activity Type • Strengths: • Meetings, workshops, international conferences • Policy advocacy • Capacity building • Gaps: • Resource mobilization • Budget advocacy • Research and anlaysis • Questions for discussion • Can the most observed activity types be considered ‘strengths,’ or an area to better coordinate support? • Can funding be re-allocated to leverage comparative advantage among network of partners to increase impact? • Next steps: • Deeper engagement with GHI / NGO focal points may reveal the scope and magnitude of the activity type reported here; more ought to be known about funding level, sub-national geography, in-country engagement

30. Profile: Target Populations

31. Summary observations: Target Populations • Strengths: • Marginalized populations • Adolescent health • Child health • Gaps: • Maternal health • Newborn health • Questions for discussion • How can/should target populations be further specified to understand where NGOs are focusing their support? (e.g., which marginalized populations) • In an effort to coordinate funding, is there value in identifying / choosing a CSO to “lead” efforts? (e.g., one whose expertise exhibits the greatest breadth across priority populations) • Is there value in either specifying catchment area to identify and mitigate overlap? • Next steps: • Determine what coordination might look like – harmonizing in an effort to minimize overlap and maximize fuller geographic overage? If there is value in having a cluster lead for certain populations?

32. Profile: Target Audience

33. Summary observations: Target Audience • Strengths: • NGO / CSO • Community members • Health workers • Local government • Gaps: • Private Sector • Media • Ministry of Finance • Academia • Questions for discussion • Which of the key audiences that are not currently being engaged might offer the greatest opportunities? • What would be needed from CSOs (and GHIs) to shift engagement towards these high priority stakeholders? • Next steps: • A deeper analysis of stakeholder engagement may reveal the constellation of partners, and indicate at the national and sub-national levels where greater coordination will add the greatest value.