Global Financing Facility investments for vulnerable populations: content analysis regarding maternal and newborn health and stillbirths in 11 African countries, 2015 to 2019

Figures & data

Table 1. Search terms by category with the content analysis framework for Mentions, Mindset, Measures and Money.

Concept category	Related search terms
MENTIONS of mortality outcomes
Maternal mortality	maternal death, maternal mortality, MMR
Stillbirth	Stillb*, SBR, perinatal death, fetal death, still birth
Newborn mortality	Newborn death, new-born death, neonatal death, NMR
MINDSET, MEASURES, MONEY: care packages along MNH continuum (thematic content analysis)
Pregnancy care	antenatal, ANC, PMTCT, abortion, pregnan* (pregnant; pregnancy)
Childbirth care	skilled birth attend, SBA, skilled attend, ‘delivery’~ EmOC, EmONC, EmNOC, obstetric, resus, perinatal^ ~ delivery in relation to childbirth ^ including related to MPDSR
Postnatal care	postnatal, PNC, breast, milk
Small and sick newborn care	preterm, pre-term, prem*, Kangaroo, KMC, ‘birth weight’ - looking for low birth weight, LBW, Sick and small newborn (small and sick *), neonatal infection, ‘sepsis’ - include only for newborn or neonatal sepsis
Related health system issues	quality, quality of care, quality assurance, midw*, referral, ‘family’ - looking for family-centred, ‘respect’ - looking for respectful care/disrespect&abuse

Figure 1. Framework for content analysis components: Mindset, Measures and Money.

Figure 2. MNH policy content analysis across the continuum of care: mindset, measures and money (a) pregnancy and/or childbirth care (b) postnatal and small and sick newborn. Themes included care packages along the continuum of care. Blue colour was used for pregnancy and childbirth and purple colours was used for postnatal and small and sick newborn care.

Box 1. Stillbirth content.

For the most part, the GFF country documents rarely mention stillbirths specifically with few exceptions. All ICs include at least one mention of the related search terms; though these ranges from only one mention (e.g. Côte d’Ivoire, Ethiopia, Mali, Malawi, Senegal) to 36 mentions (e.g. Tanzania). Burkina Faso does not mention stillbirth as an outcome but as it relates to Civil Registration and Vital Statistics. Stillbirth is included as a mortality target only in one country (Tanzania) and is included in the results framework in six ICs (Ethiopia, Liberia, Kenya, Senegal, Uganda, Tanzania). The PADs mentions stillbirth even less with four countries not including it at all (Burkina Faso, Ethiopia, Mali, and Nigeria – all three PADs), and if it is mentioned, it is only once or few times as part of the background (Malawi, Liberia, Senegal) or part of maternal and perinatal audit (Kenya, Uganda, Cote d’Ivoire). Two exceptions include Cote d’Ivoire’s PAD, which describes a pilot project for mobile ultrasound clinic to identify high-risk pregnancies through fetal heartrate monitoring and reduce perinatal mortality and morbidity, and Tanzania’s PAD, which includes it as part of capturing maternal and perinatal deaths that take place in the community.

Table 2. Consistency of MNH content in country documents.

Country	Consistency of MNH content	Short description of MNH content
Burkina Faso	Consistent	MNH integrated throughout both documents with inclusion of targets and core coverage indicators, and specific funding allocation. PAD takes more holistic health system strengthening approach for RMNCAH with focus on EmONC for MNH.
Cote d’Ivoire	Consistent	MNH included within both documents focusing more on pregnancy and childbirth interventions.
Ethiopia	Partially consistent	MNH included with related targets and indicators as well as budgets/allocations to related interventions.
Kenya	Partially consistent	MNH included in both documents; however, PAD has narrower focus on PHC and quality improvement and regulations.
Liberia	Consistent	MNH integrated throughout both documents. Core MNH indicators are included and partly consistent although ANC absent in PAD.
Malawi	Partially consistent	MNH embedded as part of health system strengthening in the IC; however, the PAD focuses on one component within, ECD.
Mali	Partially consistent	MNH embedded strongly with specific sections and indicators in IC; the PAD only includes it as part of the broader continuum with one indicator (ANC4)
Nigeria	Partially consistent	Unique example since country has multiple PADs. Nigeria’s IC includes MNH with clear attention to maternal health and some inclusion of newborn health interventions and mentions. The 3 PADs range in focus (nutrition, primary health care, and basic health provisions including MNH services – mostly care in pregnancy and at birth).
Senegal	Partially consistent	Broad health system approach with some links to MNH interventions as well as other areas along continuum, esp adolescent health.
Tanzania	Partially consistent	Documents differ in scope and content; the PAD precedes the investment case by a year MNH integrated with focus on EmONC in the IC and broader health system strengthening in the PAD.
Uganda	Consistent	Documents related and take a holistic approach to addressing RMNCAH. More mention of interventions during pregnancy and childbirth.

Figure 3. Mentions of the three outcomes (maternal, stillbirths and newborns) in GFF country planning documents.

Figure 4. Comparison of GFF related investments to national maternal and neonatal deaths, plus stillbirths.

The PAD investment includes the GFF grant as well as other funding sources, such as The World Bank’s International Development Association (IDA) Data sources: PAD values and linked GFF contribution available in country PADs and presented in Supplementary File 4 (Table 4.5). Total number of neonatal deaths and stillbirths in 2015 accessed from UN IGME webpage [2] at childmortality.org. Total maternal deaths in 2015 accessed from UN report [3] available at http://www.who.int/publications/i/item/9789240068759

Data availability statement

The datasets used and/or analysed in this study are available from the corresponding author on reasonable request. This paper is part of the Global Health Action Special Series, “Global Financing Facility for Women, Children and Adolescents: Examining National Priorities, Processes and Investments”, available in Volume 17-01.