[{"bbox": [96, 153, 1134, 233], "category": "Text", "text": "Swedish International Development Agency, SIDA (Sweden) and the Global Alliance for Vaccines and Immunisation (GAVI). The total contribution from the HDF was USD 340 000 000 over six years (2016-2021) and the EU provided a total of EUR 126 000 000 under the 11th European Development Fund to this Fund."}, {"bbox": [96, 257, 1134, 392], "category": "Text", "text": "Zimbabwe benefits from a range of other external funding commitments including over USD 440 000 000 from the Global Fund to fight HIV, TB, Malaria (GFATM) (2018-2020), USD 25 000 for the World Bank's Global Financing Facility (GFF), in 2019 and USD 200 000 000 from the United States Agency for International Development (USAID) in 2020. These funds focus on chosen disease areas but do not provide significant technical support for key healthcare building blocks and reforms."}, {"bbox": [96, 416, 1134, 709], "category": "Text", "text": "Government financing to the health sector is growing. The balance between donor funds and domestic funds changed considerably in 2021, with domestic financing constituting 58% and external financing 42% i.e. the budget in 2021 increased to USD 1 150 000 000 from USD 668 000 000 in 2020. In 2021, Zimbabwe received USD 960 000 000 from the IMF Special Drawing Rights (SDR) in 2021. Part of these funds have been used to support recovery from the COVID-19 pandemic, for example, for COVID-19 vaccine acquisition, research and development in the pharmaceutical sector, and the revamping of six referral hospitals. At present, it is not known how much of these SDR will be allocated to health as the government indicated that other sectors, such as mining and agriculture, will also benefit. Since 2019, budget allocation for health has generally improved, reaching a peak in 2021 of 13% of the budget⁶, excluding emergency funding for COVID-19. However, the current spending is still below the Abuja Declaration target of 15% and any increases could be significantly eroded if high inflation and exchange rate devaluation return."}, {"bbox": [96, 735, 1134, 895], "category": "Text", "text": "The HDF will come to an end in December 2021 and the EU has agreed to a no-cost extension until June 2022 to ensure there is a bridge to the next phase of EU support. In the coming years, major donors (EU, UK, Ireland and Sweden) plan to reduce their financial support to the health sector. The EU is planning to contribute over a four-year period, starting in 2021, up to a total of EUR 41 000 000 (approx. 40% less than for the preceding three-year period under the HDF). Therefore, domestic resource mobilisation is needed to ensure sustainability and a phasing-out plan in the long run."}, {"bbox": [96, 920, 1134, 1187], "category": "Text", "text": "In this complex context, a new multi-donor health programme, provisionally called the Health Resilience and sustainability Fund (HRF) 2021-2025, will replace the HDF. The aim of the new HRF is to continue supporting basic health in ways that will complement government funding. The focus will be on four critical strategies to (i) securing the gains achieved through the HDF by maintaining a focus on essential health services, with consideration of gender needs; (ii) improving accountability and transparency in the provision of quality health services (iii) strengthening health security, including promoting digital tools to increase efficiency (iv) ensuring environmentally sustainable PHC facilities. These activities will contribute to SDGs 2, 3, 5 and 10, deliver on key priorities in Zimbabwe's National Health Strategy 2021-2015, and support the EU's gender equality and disability inclusion priorities. An estimated 70% of the EU contribution to this action will support the TEI on Gender Equality and Women's Empowerment."}, {"bbox": [96, 1212, 1134, 1399], "category": "Text", "text": "Advocacy and leveraging domestic funding for sustainability and gradual exit from the HDF is a priority for the government to decrease its dependency on donors. At a high-level policy dialogue, that took place on 3rd November 2021, the Ministry of Finance and Economic Development announced that the government is committed to increasing public expenditure in health per capita by 2025 to USD 160 from the current USD 80 per capita. The post-HDF programme Theory of Change (ToC) is that the government will gradually take over the funding of the health sector, but external support is still needed in the medium term to propel the health system towards a 'programmatic tipping point' beyond which local resources could be used to sustain results."}, {"bbox": [96, 1424, 1134, 1506], "category": "Text", "text": "Therefore, under the new Health Resilience Fund (HRF), sustainability includes institutional elements (e.g. integrated planning); financing elements (e.g. innovation to expand fiscal space); and technical elements (e.g. leveraging technologies to enhance efficiency)."}, {"bbox": [85, 1589, 425, 1615], "category": "Footnote", "text": "⁶ This is below the Abuja target of 15%."}, {"bbox": [608, 1638, 623, 1660], "category": "Page-footer", "text": "6"}]