In 2012, the United Nations Commission on Life-Saving Commodities for Women and Children (UNCoLSC) recommended increased access to 13 low-cost/high-impact commodities for Reproductive, Maternal, Newborn and Child Health (RMNCH), to reduce preventable deaths and accelerate achievement of MDGs 4 and 5. Funding support was provided by Norway and Great Britain. The RMNCH Trust Fund (TF) was established and operated from 2013 to 2016 (with an extension for some countries into 2017) to support implementation. In 2013, the mandate of the RMNCH Trust Fund was expanded to encompass bottlenecks and gaps beyond commodities that were inhibiting achievement of MDGs 4 and 5. A multi-agency Strategy and Coordination Team (SCT) for the RMNCH Trust Fund housed at UNICEF, included representation from UNICEF, UNFPA, WHO, and the World Bank.
EHG was contracted to carry out an end of fund assessment from January to June 2017. The focus was an in-depth analysis of country level activities in 19 countries, using a contribution analysis approach. Case study countries included: D.R. Congo, Malawi, Mali, Tanzania and, Uganda. In addition to field visits, the methodology included development of a theory of change, an evaluation matrix of assumptions and questions, a comprehensive review of documents from ten priority countries and an online survey of selected RMNCH TF partners in 14 countries (not including the five field visit countries).
In summary, the availability and flexibility of TF funding were its primary benefits, closely tied to the fact that it focused very specifically on government priorities and existing plans, rather than introducing new approaches or ideas. At country level, the initiative was government led, and the country engagement process increased cooperation among partners from different sectors towards a common goal. It contributed to a careful selection of domain and areas of intervention, based on a robust gap analysis, and needs assessment. Simple processes were employed to programme and re-programme when realities changed, and this enabled countries to adapt to new situations. The capacity of health workers, especially in rural areas and areas with poor MNCH indicators, was improved, and health workers continue to ask for additional mentoring and coaching support. Linkages between communities and facilities were enhanced through coordination processes established. Some countries reported increased local manufacture of products e.g. amoxicillin and chlorhexidine, and consequent reduction in price, and increased availability of the 13 underutilized LSCs has been reported. Leveraging additional resources, a longer duration of implementation, and wider geographic focus are necessary to achieve significant and sustainable impact. Perhaps because of the short duration of the project, there was limited resource mobilization to continue and an insufficient focus on transition from the TF. Future projects should emphasise earlier engagement of the sub-national level, evaluation and documentation of key interventions across countries to ensure that valuable lessons learned are shared and scaled up, and an explicit exit strategy should be planned.
As a consequence of the RMNCH Trust Fund, mindsets were changed and revitalized on the importance of RMNCH, after somewhat of a lull in visibility. In particular, expansion of RMNCH in line with national priorities, building on existing or planned interventions was much appreciated by country partners.