10 YEARS
of actions for the health and well-being of women, newborns, children and adolescents in West and Central Africa
PROLOGUE
THE FRENCH MUSKOKA FUND IS CELEBRATING ITS 10TH THIS YEAR.
As France’s contribution to the commitments for maternal and child health made by the G8 countries in 2010 in Muskoka, Canada (after which it was named), this effective partnership relies on the complementary expertise of four United Nations agencies: UN Women, UNFPA, UNICEF and WHO.
Its rare longevity can be explained by its innovative approach, its ability to adapt to the local context, and above all by the results it has achieved in reproductive, maternal, neonatal, child and adolescent health as well as nutrition – as many issues that are at the center of France’s development strategy.
This initiative also contributes to the implementation of the “great cause” of France’s diplomacy: equality between women and men.
The French Muskoka Fund implements “high-impact interventions” (whose effectiveness has been carefully reviewed and which help leveraging the impact of national policies) in nine countries of Central and West Africa: Benin, Burkina Faso, Chad, Cote d’Ivoire, Guinea, Mali, Niger, Senegal and Togo. In line with the 2030 Agenda and the Global Strategy for Women’s, Children’s and Youth Health (2016-2030), this partnership aims at achieving sustainable results through a multi-sectoral approach and health systems strengthening (including community health systems).
The French Muskoka Fund supports its beneficiaries in both urban and rural areas throughout their life cycle: from pregnant women and mothers to newborns, children, adolescents and youth. In 10 years, this inclusive approach has allowed the French Muskoka Fund to achieve significant results.
As example, more than 70,000 health workers have been trained; infant and child mortality has decreased by more than 30%; the rate of births attended by qualified personnel has increased from 50 to 70% in Côte d’Ivoire; and 1.6 million children have been treated for malaria, diarrhea and respiratory infections in Guinea.
The COVID-19 pandemic has strained the resilience of health systems in West and Central Africa. More than 300,000 cases have been officially diagnosed since March 2020 – affecting many health workers and there are probably many more. There has also been a sharp decline in the use of health care services. As example, children’s consultations for infectious diseases have declined by 25% in Senegal. To limit the impact of the pandemic and help maintain essential services for women, children and adolescents, the French Muskoka Fund is supporting governments with innovative responses, such as in Niger where mobile teams (midwives, nurses and gynecologists) are being deployed to decentralize pre- and post-natal care, or in Chad where community health workers have been helping monitor women victims of gender-based violence. Funding dedicated to health systems strengthening has also been increased and now accounts for a quarter of the Fund’s budget.
France is convinced that this partnership is a relevant response to the challenges of reproductive, maternal, neonatal, child and adolescent health and nutrition in West and Central Africa. This is why the French Muskoka Fund was showcased throughout the Generation Equality Forum organized in Paris in July 2021, and especially under the Action Coalition on sexual and reproductive health and rights. France has also renewed its commitment by extending its 10 million Euro financial contribution for another five years (until 2026). The Fund itself has committed to investing more in the development of edutainment tools to act on social norms and to accompany behavioral changes in a sustainable and equitable manner – capitalizing on the successful initiative «C’est La Vie!/That’s Life’’ (a TV and radio show that it is produced and broadcast in local languages throughout West and central Africa). I therefore wish a long life to the French Muskoka Fund, encourage all its actors to continue their efforts, and thank them for contributing to improving the health and wellbeing of the populations in West and Central Africa by providing more equitable life opportunities to all women and their newborns.
Philippe Lacoste
Director of Sustainable Development
Ministry of Europe and Foreign Affairs
CONTEXT
A REGIONAL CONTEXT MARKED BY MANY CHALLENGES
Worrying health indicators
Maternal mortality rate per 100,000 live births:
- World: 211
- Sub-Saharan African countries: 542
- Chad: 1140
Infant mortality rate (children under 5): multiplied by 24 compared to European countries.
A severe shortage of human health resources
This is one of the major challenges for access to health for populations: there is a serious lack of human health resources in sub-Saharan African countries, with an average of 1 nurse / midwife per 1,000 inhabitants.
There was already an estimated 4.2 million caregiver shortage in African countries in 2013.
The WHO estimates that there will be a global shortage of 18 million health workers by 2030.
Many factors explaining the lack of progress in health indicators
Other factors also explain the lack of progress in health indicators in the region: cyclical shocks (conflicts, epidemics, natural disasters), chronic poverty, poor access to basic social services, especially health services and education, gender inequalities, including gender-based violence (GBV).
GOALS
BRIEF OVERVIEW OF THE MUSKOKA FRENCH FUND
Since 2011, the French Muskoka Fund has been working to improve the health and well-being of women, newborns, children and adolescents in nine countries of West and Central Africa: Benin, Burkina Faso Faso, Côte d’Ivoire, Guinea, Mali, Niger, Senegal, Chad and Togo.
Its creation responds to France’s commitment, at the G8 summit in Muskoka, Canada, in June 2010, to strengthen its contribution to reproductive, maternal, newborn, child and adolescent health (SRMNIA). , nutrition and the empowerment of women in order to achieve the Millennium Development Goals (MDGs) on improving maternal health and reducing child mortality.
The French Muskoka Fund acts by mobilizing the comparative advantages and complementary expertise of four United Nations agencies: the World Health Organization (WHO), UN Women, the United Nations Population Fund (UNFPA) and the United Nations Fund for United Nations for Children (UNICEF).
Les pays
France has allocated more than 144 million euros between 2011 and 2020 for the implementation of the activities of the French Muskoka Fund.
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2011-2016: initial duration of five years
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2017-2018: extension for two more years
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2018-2022: renewal for a period of five years
As a further guarantee of the recognition of its effectiveness, Denmark wished to make a contribution of 3 million euros to the French Muskoka Fund over the period 2019-2020
Financial aspects
The distribution of funds between the agencies is defined each year by the Ministry for Europe and Foreign Affairs (and the Danish government regarding its contribution).
million euros allocated under the French Muskoka Fund by France (2011-2020) and Denmark (2019-2020)
%
allocated funds were used directly to support High Impact Interventions (HIIs) implemented in target countries.
%
performance for the ratio between funds allocated and funds used, over the ten years of the French Muskoka Fund
TEStimonials
key results
The high impact interventions (IHI) implemented within the framework of the French Muskoka Fund are defined and programmed in line with the national health development plans of the countries and according to the target populations to be reached: pregnant women, newborns, children , adolescents and women.
Some examples :
PREGNANT WOMEN AND NEWBORNS
rose from 15.58% in 2016 to 27.54% in 2020.
In Niger: The first national feedback bulletin on the implementation of the SDMR was produced in 2019.
In Burkina Faso: The exclusive breastfeeding rate for infants fell from 38% in 2012 to 64% in 2020 and chronic malnutrition fell from 33% in 2012 to 25% in 2020.
CHILDREN
community health worker in Kara and Savanes.
Chad: In 2019, the vitamin A supplementation campaign covered
91% of children aged 6 to 59 months.
Guinea: nearly 1.6 million children were taken care of between
2011 and 2020 as part of the treatment of malaria,
diarrhea and respiratory infections. Vitamin A supplementation coverage increased from 70% in 2012 to 90% in 2020.
Mali, coverage for the DTP3 vaccine increased from 72% in 2011 to 97% in 2019.
TEENAGERS AND PREGNANT WOMEN
2012 to 23.2% in 2017.
Ivory Coast: The French Muskoka Fund has helped disseminate and supervise ECS lessons to 71.4% of new high school students. The country has also adopted a national reference document on menstrual health and hygiene.
Niger: broadcast of interactive radio programs on the links between GBV and maternal and child health, reaching nearly 1.4 million listeners (men, women, teenagers).
EQUITABLE ACCESS TO QUALIFIED HEALTH STAFF
United Nations, the French Muskoka Fund has helped to strengthen
the capacities of more than 70,000 health workers in the nine
target countries: training, financial support, supply of equipment
and materials, evaluation and improvement of practice, improvement
working conditions.
added value
The French Muskoka Fund has real added value in all aspects of its interventions:
methodology
methodology
The French Muskoka Fund is a model for implementing the “One UN” reform, which aims to improve collaboration between the various United Nations agencies, with the objective of improving consistency, efficiency and impact programs implemented:
– a set of high impact interventions (IHI) based on the complementarity and technical expertise of each of the four agencies;
– joint monitoring and reporting of activities, results and financial execution;
– mobilization of other technical and financial partners;
– common documentation of interesting practices.
Programmatic
Programmatic
The French Muskoka Fund develops interventions adapted to each of the key target populations and acts on the determinants of maternal and infant mortality and morbidity.
strategy
strategy
The French Muskoka Fund aligns its interventions with the sectoral strategies of the United Nations, in particular the Global Strategy for Women’s, Children’s and Teenagers’ Health (2016-2030) and the framework of the Sustainable Development Goals (SDGs). ), and ensures that its programs are part of the national plans of the target countries.
financial management
financial management
The French Muskoka Fund benefits from a secure multi-year budgetary allocation for its interventions, making it possible to implement ambitious interventions with the desire to achieve long-term results.
The mechanisms of rapid disbursement, monitoring and tight reporting reinforce the financial stability of the Fund.
LESSONS LEARNED and OPPORTUNITIES
Over the years, the French Muskoka Fund has learned valuable lessons from the implementation of its interventions and learned opportunities, with some constraints:
OPPORTUNITIES:
Personal involvement of the representatives of each agency
This involvement is essential for its strategic support and its visibility in the target countries. It has deepened over time, allowing the French Muskoka Fund to become a key lever of influence and action on maternal and child morbidity.
At country level, the lead agency plays a crucial role
for the proper functioning of the system as a privileged interlocutor, entry and exit point for communications with the regional level, organizer and facilitator of meetings with other agencies.
A common technical and financial annual report
The common technical and financial annual report is a very important tool in terms of accountability, visibility and advocacy. It is also a tool for evaluating and improving the practices of country teams.
Develop and maintain a multi-year vision
In order to optimize the results achieved and the impact of interventions, it is essential to develop and maintain a multi-year vision and to operate within a stable strategic framework containing clear directions arising from the COPIL and COTECH.
Involvement of regional advisers in global health in the system
The involvement of Regional Advisers in Global Health in the system has proven to be a good practice for facilitating exchanges between country teams and Embassies. It provided an additional channel of communication with the agencies and the Ministry of Europe and Foreign Affairs, and the organization of high-level events with the support of the Embassies.
CONSTRAINTS:
Planning
On the one hand, the annual nature of the programming creates a very dense period of activity (from November to February) concentrating the closure of interventions, reporting, programming for the following year, budget allocation and start-up. new activities. On the other hand, the short implementation period (March / April to December) poses the challenge of the speed of disbursement of funds each year. Finally, depending on their own activities, the national partners of the target countries are not always available at the key stages of the French Muskoka Fund’s planning cycle.
External environment
The political situation (electoral deadlines) and security (terrorist risk), climatic hazards (rainy season) or even health disasters (epidemics such as Ebola or COVID-19) represent all obstacles to the implementation of interventions . – Coordination: the target countries must further strengthen their internal coordination (interministerial coordination).
Administration
On the one hand, there are bottlenecks in the expenditure procedures for the disbursement of funds and the implementation of activities. In most of the target countries, health information systems are underdeveloped, which slows down reporting on many indicators.
Human ressources
In most of the target countries, the implementation of interventions is hampered by a lack of quality human resources for health. This is why the training, distribution and motivation of health personnel constitutes one of the major areas of intervention of the French Muskoka Fund.
Logistics
The continued supply of quality health commodities for maternal and child health remains a major challenge in target countries due to weak planning processes and supply and distribution chains.
CHALLENGES
Beyond organizational constraints, the French Muskoka Fund must find a way to respond to three main challenges:
changing demographic context
changing demographic context
In addition to the instability of the political, security, economic, social and climatic environment in which the teams operate, the French Muskoka Fund must contend with the weight of socio-cultural determinants, strong demographic growth and low national budgets allocated by governments.
The multiplication of partners
The multiplication of partners
The growing number of technical and financial partners involved in maternal, newborn and child health in target countries increasingly poses the challenge of coordination in order to avoid the fragmentation of interventions and the achievement of sub-optimal results. As such, coordination with AFD in particular should be strengthened.
The financial perspective
The financial perspective
In a perspective of evolution and growth, the French Muskoka Fund must explore other funding opportunities.
IN CONCLUSION
This year, the French Muskoka Fund is celebrating its tenth anniversary. Its teams can be delighted with its rare longevity for such a device bringing together so many partners and intervening in a difficult context marked by chronic instability on the political, security, institutional, economic, social and environmental levels.
Fully in line with the various strategic frameworks of the United Nations on the one hand, and in alignment with the national development plans of the countries on the other hand, the French Muskoka Fund has been able to set up a model mechanism for joint programming and coordination of United Nations agencies. This one-of-a-kind partnership, which maximizes the efficiency of the resources used, rose to the challenge of a successful collaboration focused on results and impact.
%
Maternal mortality rate between 2010 and 2017
%
Neonatal mortality rate between 2011 and 2018
health staff trained in 10 years
As the year 2021 marks the beginning of the decisive decade for the achievement of the Sustainable Development Goals by 2030, and in the face of the many crises that capture the attention of the international community, starting with the COVID pandemic -19, the French Muskoka Fund embodies hope by keeping maternal and child health at the heart of the health development agenda of its technical and financial partners and the governments of its countries of intervention.
It still has to intensify its efforts in terms of visibility, in order to encourage mobilization at the highest level and thus carry the commitments of France, which is its main financial partner.