Optimizing Global Fund proposals to promote women's and children's health

Integrating RMNCH

Successfully integrating RMNCH in Global Fund proposals

Proposals that strengthen health systems and community systems and integrate the RMNCH continuum of care with HIV/AIDS, TB and malaria strategies, ensure value for money, promote human rights and strengthen accountability for results. Accordingly, they will be well-positioned to promote women’s and children’s health through the Global Fund’s mandate and resource envelope.

Ensure a continuum of care for women, men, children and families

There are multiple points along the RMNCH continuum of care where interventions can be integrated with HIV/AIDS, TB and malaria strategies (See Figure 1). Key entry points for integrating services are sexual and reproductive health services, antenatal care, PMTCT, post-natal care, and providing nutritional, psychosocial and socioeconomic support for women and children who are especially vulnerable (See Box 1 for technical resources that provide details about specific interventions and entry points).

Strengthen health systems

Inadequate health systems are a primary obstacle to scaling up interventions to improve women’s and children’s health.12 For health systems, having sufficient numbers of trained, qualified health workers in the right place, at the right time and with the right resources is crucial to the provision of essential services.13 The Global Fund has emphasized the importance of Health Systems Strengthening (HSS) since Round 5. The Health Systems Funding Platform (HSFP) is a joint initiative between the Global Fund, the GAVI Alliance and the World Bank to align strategies and make better use of new and existing funds for HSS.14

Strengthen community systems

Community systems include methods and structures used by communities to meet their health needs. Successful proposals should ensure that community systems interact either directly with health systems by providing services or by promoting access, or indirectly by improving social, political, legal, economic and physical environments that support health.15

Emphasize additionality and value for money

Proposals for new funding are additional when they supplement, but do not duplicate, other programmes and funding sources. Strategies demonstrate value for money when they demonstrate quality, economy, efficiency and effectiveness. For example, almost 50% of Global Fund investment is for procurement/purchasing commodities. Medicines account for three of the most common causes of inefficiency in health systems.12 In many settings there is poor storage, leading to wastage, and wide variations in the prices procurement agencies negotiate with suppliers. Addressing these issues would result in cost-savings and efficiencies. Maximizing value for money in integrating RMNCH with strategies for the three diseases requires sound operational research, and countries should fully utilise the 5% of grant funds available through the GF for this purpose.

Realize human rights, address inequities, combat stigma and prevent discrimination

Promoting awareness of rights, advocating for equality of access to essential services, ensuring legal entitlements, and mitigating stigma and inequity are essential elements of a human rights approach to promoting women’s and children’s health.16 Successful integration of RMNCH interventions with HIV/AIDS, TB and malaria strategies requires preventing discrimination across all dimensions of access to quality healthcare for women and children: accessibility, affordability, acceptability, appropriateness, and quality of services. It also requires efforts to address the underlying risk factors and determinants of disease in vulnerable groups and to improve coverage and outcomes in underserved populations, such as reduced new infection rates and improvements in survival and health status.

Promote accountability for results at all levels

Shared indicators for monitoring and evaluating will help track progress towards MDGs 4, 5 and 6. The Commission on Information and Accountability for Women’s and Children’s Health provides a framework for strengthening health information systems and includes consensus on tracking 11 core RMNCH indicators, which include antiretroviral prophylaxis among HIV-positive pregnant women, antenatal care coverage, children under five who are stunted, maternal mortality ratio and underfive child mortality.17 Integrating monitoring and evaluation (M&E) for RMNCH and for HIV/AIDS, TB and malaria programs will help ensure accountability for results at all levels, and promote learning across contexts on addressing constraints and building on successes to promote women’s and children’s health.