CHAI - Health Systems for SRHR and UHC in Sub-Saharan Africa: 2022-2026

In the second year of this engagement, CHAI collaborated with governments and regional partners to make progress towards the following key priorities. 1. Supported design and implementation of an explicit, prioritized, evidence-based benefits package that includes SRH and PHC services in Ethiopia, Malawi, Rwanda, Eswatini, Uganda, and two states in Northern Nigeria. Supported institutionalization of evidence-based priority-setting in Ethiopia and Rwanda. 2. Addressed resource gaps for government priorities by quantifying resource needs against national plans and mobilizing domestic and external resources towards these gaps in all case study countries (Ethiopia, Eswatini, Nigeria, South Africa, Malawi, Rwanda, and Uganda), as well as secondary countries with co-funding (Zimbabwe, Mali, Tanzania, DRC, and Burkina Faso) from the Global Financing Facility. 3. Strengthened coverage, resourcing, efficiency, and gender-responsiveness of pre-payment systems to reduce out-of-pocket spending as a barrier to SRH services in Ethiopia, Nigeria, and Rwanda 4. Strengthened systems and capacities to improve efficiency, equity, and accountability in how funds are managed and used, through reforms to provider payment in Ethiopia, Rwanda, Malawi, and South Africa, and support for subnational financial management across all case study countries. 5. Improved access to SRH services through performance management and systems strengthening; ensuring that funds are not only available but translate into improved service delivery and access to commodities in all case study countries. 6. Shared work across the region, including through public dissemination, regional partnerships, and intergovernmental exchange. 7. Supported sustainable generation of evidence to policy via partnerships with universities and Africa CDC.

CHAIs goal for the proposed engagement (2022-2026) is to accelerate regional progress towards UHC and SRHR, by strengthening health systems to sustainable increase of equitable access to quality, integrated PHC and SRH services. The overall impact result of the intervention is improved and more equitable health outcomes for women, adolescents, children and other vulnerable groups including internally displaced persons, migrants, and refugees, and the poor. This will be done through increased financial risk protection and increased and more equitable effective coverage of PHC and SRHR. Taken together it is expected that the programme will contribute to reduced maternal mortality, reduced neonatal mortality and reduced adolescent fertility rate which are included as key impact indicators in the results framework. Specifically, CHAI will support governments in the following objectives: Objective 1: Define priorities, inclusive of integrated PHC and SRHR, through an evidence-based, participatory process; linking these priorities to how resources are allocated. Objective 2: Mobilize external and domestic resources for these priorities. This includes working with Ministries of Health to engage Ministries of Finance and donors to mobilize and release funds, increasingly channeled through government systems, as well as development and implementation of long-term health financing strategies. Objective 3: Extend financial protection through pooling and pre-payment systems responsive to vulnerable groups including women, adolescents, children, and especially the poor. This ranges from development of policies and strengthening new institutions, such as government insurance agencies, to efficient implementation and management of systems towards increased and more equitable coverage. Objective 4: Improve efficiency, equity, and accountability in how available funds are managed and used to pay for these priority areas, including through changing how providers are contracted and paid and strengthening public financial management systems from national to sub-national level. Objective 5: Identify and address management challenges and other systems constraints to integrated, gender responsive, quality PHC and SRHR. This includes supporting identification of systems constraints or bottlenecks and using routine data to inform operational planning, performance management and changes in how services are delivered through work at sub-national level that is scaled and sustained by governments.