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Save the Children UK
The GFF has made significant strides since its inception in 2015. It has mobilised major new World Bank funds in several countries, shifted a greater proportion of domestic resources into health and nutrition services, and has pushed a variety of efficiency gains in countries. Most importantly, it has demonstrated potential to positively disrupt the development financing landscape, make genuine inroads into the health and nutrition financing gap, and quicken the pace of systems strengthening. The GFF is not perfect – no mechanism is after three years, as shown by the successful long-term improvements the Global Fund and Gavi needed to make – but as Save the Children’s April 2018 briefing indicated, it has huge potential and with a few reforms the GFF can ensure that it fulfils its promise.
However, more must be done; it remains clear that the GFF’s model does not raise sustainable, new domestic resources in significant enough quantities. The only way the GFF can do this is to break new ground and engage fully with progressive, wide-ranging tax reform in the countries in which it operates. We know that use of official development assistance for tax can be effective, and it is also clear that increased state revenues are essential in provision of adequate financing for health and nutrition, and can directly lead to increased spending on social sectors . Engagement with domestic tax regimes would also be coherent with the GFF’s theory of change – to use small amounts of grant funding to mobilise larger quantities of domestic resource, to promote country ownership, and to advance equity.
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