World Bank and the Global Financing Facility

A t the World Economic Forum this year, World Bank President Jim Kim proposed the Global Financing Facility (GFF) to donors as an innovative model for investing in reproductive, maternal, newborn, child, and adolescent health and nutrition (RMNCAH-N). The World Bank believes that business as usual is not enough to close the annual financing gap of $33.3bn (£25.4bn; €28.4bn) to meet the 2030 sustainable development goals for RMNCAH-N. Its latest offering—the GFF—is designed as a catalyst to close this gap, as every dollar invested by donors will be linked with $4 of bank credits, multiplying the effect of donor contributions in countries where action is needed the most. Since its inception in July 2015 and implementation in seven high burden countries to date, 4 the GFF has been lauded and criticised in equal measure. 6 In this article, we explain the origins and mechanism of the GFF, and discuss the benefits and some initial concerns about this investment model. Origins of the GFF The GFF is a multidonor trust fund managed by the World Bank with financial commitments from bilateral donors and private foundations of more than $1bn (fig 1). The GFF is based on the existing Health Results Innovation Trust Fund (HRITF) managed by the World Bank and supported by Norway and the UK through commitments of $575m from 2007 to 2022. The HRITF supports results based financing interventions whereby providers are paid on achieving planned indicators to improve the coverage and quality of maternal and child health services. Country programmes under the HRITF are financed by linking grants from the trust fund with credit from the World Bank’s concessional lending arm—the International Development Association (IDA). Evaluation of the HRITF showed that while results based financing improves service coverage and quality, albeit with variations across interventions, the key recommendation of a strategic, scaled, and sustainable framework that views results based financing as an entry point for tackling health system problems is not always easy to implement, especially in weak health systems. The GFF grew out of this recommendation under the leadership of World Bank president Jim Kim and Tim Evans, the senior director of the health, nutrition, and population sector. 12