As program director at Results for Development (R4D), Ms. Miller manages the West Africa portfolio on the Health Systems Strengthening Accelerator project. She supports in-country and regional partners in Côte d’Ivoire, Guinea, and Togo to analyze health system challenges, develop theories of change, translate knowledge from other contexts, co-create innovations where needed, facilitate prioritization of action and adapt approaches based on learning.

Throughout her career, Ms. Miller has focused on expanding access to high-impact evidence-based health interventions to increase quality, coverage, and support policy. At the Elizabeth Glaser Pediatric AIDS Foundation, she co-chaired a technical advisory group for country adaptation of the revised WHO PMTCT guidelines, developed three toolkits for country-level adaptation and implementation of the revised guidelines and published a peer-reviewed publication in the Bulletin of the World Health Organization. While at IMA World Health, she worked with the Haiti Ministry of Public Health and Population to co-author the country’s first national strategic plan for morbidity management and disability prevention plan for lymphatic filariasis. Ms. Miller is currently a doctoral candidate at the Milken Institute School of Public Health at the George Washington University, and recently had an article accepted for publication in the Pan American Journal of Public Health on intimate partner violence during pregnancy in Guyana.

Before joining R4D, Ms. Miller was senior technical program manager at IMA World Health where she supported the response to the Ebola outbreak in Eastern Congo, implementing Ebola prevention and response services and strengthening access to essential primary health care in ten of the 28 most affected health zones. Prior to IMA, she managed the start up of the $195M PEPFAR-funded Adolescents and Children HIV Incidence Reduction, Empowerment and Virus Elimination (ACHIEVE) project at Pact.

As the senior program officer for JSI on the Maternal and Child Survival Program, she managed the Democratic Republic of Congo and Burkina Faso portfolios, collaborating with in-country project staff, Ministry of Health officials, and other partners to increase access to maternal and child health services and to develop the DRC’s national scale-up plan for integrated community case management.

Ms. Miller has served on the board of the Cameroon Health and Education Fund since 2010.

Ms. Miller holds a master’s degree in health, community, and development from the London School of Economics and Political Science and a bachelor’s degree from McGill University. She is a native speaker of English and speaks fluent French.

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SPARC is not just a resource center but a movement. SPARC is engaging as many stakeholder groups across Africa to understand, talk about, and advocate for strategic purchasing to make better use of limited resources for UHC and to hold governments accountable for effective health spending.

Between July 25-28 2022, SPARC convened 80 representatives from Ministries of Health, National Health Insurance agencies, the technical partners consortium, and coaches who support SPARC country engagements from 11 African countries ( Benin, Burkina Faso, Democratic Republic of Congo, Cameroon, Ethiopia, Gambia, Ghana, Kenya, Nigeria, Rwanda, Tanzania and Uganda). At this convening, SPARC hosted a learning exchange between these countries on advancing strategic health purchasing through the government budget.

Why the government budget?

In many African countries, the government budget remains the largest pool of funds. Although the government budget has not been fully leveraged for strategic purchasing, there is growing interest in the region in introducing new health financing arrangements that operate in parallel with the government budget, such as contributory national health insurance, community-based health insurance, and other schemes. It’s clear the government budget remains the most effective and equitable vehicle for strategic purchasing.

It is widely acknowledged that more public resources are required to advance UHC objectives — and public funds — including on-budget donor resources channeled through the government budget, allowing for pooling and allocation of resources to providers in a way that aligns with population health needs. Recognizing the value of the government budget and the opportunities therein, representatives from Burkina Faso, Kenya, Nigeria, Tanzania and Uganda, shared their country experience using the government budget to improve strategic purchasing and remaining obstacles to be overcome.

Resisting further fragmentation by channeling the government budget in existing schemes

Multiple schemes in countries, fragment health resources flowing through the schemes reducing the purchasers’ power to exert influence on how resources are allocated, and the incentives to providers for high quality care. When new schemes are established, often times they worsen the fragmentation in the system by adding a new scheme rather than building on what exists.

Tanzania’s Basket-funding, however, aimed to reduce fragmentation by pooling the government budget and on-budget donor resources into one pool and channeling resources directly to primary health care providers (PHC) through the Direct Health Facility Financing (DHFF) for priority maternal and child health (MCH) services.

In Nigeria, the Basic Health Care Provision Fund channels 1% of consolidated government revenue through three gateways to the National Primary Healthcare Development Agency to finance inputs for PHC providers; to the National and State Health Insurance Agencies to extend insurance coverage to vulnerable groups, and for emergency and pandemic related health services. In so doing, the government budget is building on existing purchasing agencies to transfer resources to providers targeted at PHC and addressing the needs of the most vulnerable population groups.

Prioritizing vulnerable groups and priority services

Channeling the government budget toward priority health services and/or population groups, such as women and children, in a bid to reduce maternal and infant mortality can move countries closer to achieving the sustainable development goals and UHC. The Gratuite program in Burkina Faso transfers government funds directly to PHC providers for MCH services. In Kenya, the “Linda Mama” program runs on a government budget subsidy channeled through Kenya’s National Hospital Insurance Fund for coverage of antenatal care, health facility delivery and postnatal care. In Uganda, budget guidelines stipulate that 30% of facility resources must be used for preventive health services and limits the district health facility budget spending on administration to 15% while the rest should be used for service delivery.

Using the government budget to increase provider autonomy

Provider autonomy refers to the degree of financial and management autonomy health managers have to receive funds, use these funds, and respond to the incentives in provider payment systems. Government budgets are associated with rigid rules for spending public resources to ensure accountability for how these resources are used but may limit how providers can spend resources they receive.

Tanzania’s DHFF recognized PHC providers as accounting units, allowing them to receive public resources, and expanded the decision space for managers to develop facility plans in collaboration with community representatives. DHFF also bypassed the bottlenecks and delays at the district level by transferring resources directly to the PHC level. This has allowed providers to be more responsive to local health priorities and allow more timely receipt of funds.

Burkina Faso’s Gratuite program also increased resources to providers and used a system of pre-payment that allowed for transfer of funds in advance to ensure adequate resourcing of providers and overcoming bottlenecks to resource flowing to the PHC level.

A similar program to transfer funds directly to PHC providers in Kenya, and increasing their autonomy implemented between 2010 and 2012, showed similar successes reducing bottlenecks at the district level, empowering providers to respond to local priorities and improving infrastructure at PHC level. Uganda provides strict guidelines to providers and follows this with supportive supervision and audits. Although this limits provider autonomy, these processes are considered necessary to improve alignment to national priorities and accountability for public resources.

Overcoming remaining obstacles

Despite these successes, there remain challenges in raising adequate resources for health, navigating the politics of moving money and power from one organization to another. For example, Burkina Faso is considering a transition of the Gratiute program to the health insurance agency; and in Kenya the devolved system of government has increased fragmentation of health resources in 47 county governments. Further, a debate on how much provider autonomy is sufficient and how to link the government budget to better performance and quality of care remain important learning questions for SPARC and the technical partners going forward.

For those considering changes in the government budget, it’s important to have a clear vision and strategy — and to look for opportunities to solve problems with steps that have the least resistance from stakeholders, while building trust along the way. For SPARC, this is only the beginning of a learning agenda that builds on these country lessons.

Photo © Strategic Purchasing Africa Resource Center

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Dr. Claeson, a globally recognized expert in maternal and child health, is former director of the Global Financing Facility. Ms. Kainyah is a seasoned multinational executive with a legal background and her own firm, Kina Advisory, which provides advice critical to sustainable development in Africa to governments and companies. Mr. Loum, former prime minister of Senegal (1998–2000), is a dedicated public servant who brings a deep understanding of the needs of government change agents, including political, technical and implementation challenges. Ms. Pace is the president and executive director of the Global Health Council, and a tireless advocate for global health programs that effectively engage and meet the needs of their communities.

Gina Lagomarsino, president and CEO of R4D, said: “Earlier this year, we adopted a new strategy, which reflects a changing global development landscape and will serve as a guide for how we design our programs and how we build organizational capabilities in the coming years. I’m thrilled to welcome our newest board members at this pivotal time. Their counsel will be critical as we work to implement our strategy and manage continued uncertainty, the global recovery from COVID-19 and the global movement toward more just and equitable societies.”

R4D continues to support change agents — government officials, civil society leaders and private sector innovators — in low- and middle-income countries as they build strong systems to achieve large-scale, lasting improvements in health, education and nutrition. R4D’s strategy, adopted in May 2020, recognizes and responds to the current situation in the world, including the COVID-19 pandemic (which has created interrelated catastrophes in health, education and nutrition) and the need to dismantle structural racism in our field. The new strategy emphasizes approaches that support country-level systems change and build strong regional ecosystems that shift the locus of technical support to country and regional institutions and experts.

David de Ferranti, R4D board chair and senior advisor, added: “I’m excited to welcome Mariam, Rosalind, Lamine and Loyce to R4D’s board of directors. This impressive group brings significant experience and expertise working as public servants and leaders in the fields of development, health, business and finance.”

Learn more about the board

Dr. Mariam Claeson

Mariam Claeson, M.D., M.P.H., is the former director of the Global Financing Facility (GFF) for Every Woman Every Child at the World Bank. Prior to the GFF, she served as director for the Maternal Newborn and Child Health team at the Bill & Melinda Gates Foundation. She also worked at the World Bank from 1998–2012, where she worked as the program coordinator for the multisectoral response to AIDS in the South Asia Region as well as task team leader for HIV operations in India and Afghanistan, among other roles.

She said: “I am excited to join the R4D family as Board member because its mission, to work with change-agents in countries to create self-sustaining systems that support healthy, well-nourished and educated people, is more urgent and relevant than ever and central to the development agenda of the 2020s. I think that R4D is well-positioned to contribute and make a difference to our collective response to global inequities.”

Learn more about Dr. Claeson.

Ms. Rosalind Kainyah

Rosalind Kainyah, L.L.M., is an environmental lawyer and founder and managing director of Kina Advisory. In this role, she works with companies to ensure they have positive socioeconomic impacts on the countries in which they operate, while realizing optimal financial value. She is a trusted advisor to boards and senior executives of global companies on responsible business investment and partnerships in emerging markets. Ms. Kainyah has almost 30 years of combined international, senior management, executive and board level experience.

“It is a privilege to be joining the board of Results for Development, and I look forward to using my passion and experience to support the great work of Gina and the rest of the R4D team to address global inequalities in health, education and nutrition. These inequalities have been exacerbated by COVID-19 and there is an urgent need for localised solutions to these challenges. By working with local agents to drive change, Results for Development is leading the way in creating long-term, sustainable improvements across the three sectors.”

Learn more about Ms. Kainyah.

Mr. Mamadou Lamine Loum

Mamadou Lamine Loum served as Prime Minister of Senegal from 1998–2000. He began his government career in Senegal as Inspector of the Treasury, which led to the post of General Treasurer and then Director General of the Treasury. He later became Deputy Minister in charge of the budget then Minister of the Economy, Finance and Planning. More recently he has worked as an independent consultant in Chad, Cameroon, Central African Republic, Democratic Republic of Congo, Burundi, Togo, Algeria, Ghana and Guinea for international organizations such as the World Bank, IMF, OIF, IDB, UNDP, African Union, UEMOA and BOAD.

He said: “I am fully committed to supporting this relatively young, but well-known organization’s efforts to support change agents to improve health, education and nutrition outcomes in low- and middle-income countries. I have focused on these important issues from many angles during my long career, and I hope to contribute to R4D’s further success.”

Learn more about Mr. Loum.

Ms. Loyce Pace

Loyce Pace, M.P.H., is the president and executive director of the Global Health Council (GHC), a leading membership organization which supports and connects global health advocates, implementers, and stakeholders worldwide. Ms. Pace is a leader who has worked in more than 15 countries delivering health programs and mobilizing advocates. She has served as GHC president and executive director since December 2016. She previously held leadership positions in global policy and strategic partnerships at LIVESTRONG Foundation and American Cancer Society.

She said: “It’s a privilege to join the board of R4D at a time when people in our sector and around the world are not only acknowledging the importance of strong health systems but also building those with underserved communities at the table. I am thrilled to support the organization and its partners in how they prioritize local leadership and civil society engagement across health and development programs, so we all emerge even stronger.”

Learn more about Ms. Pace.

To see R4D’s full list of board members, click here.

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About Results for Development
Results for Development (R4D) is a leading non-profit global development partner. We collaborate with change agents around the world — government officials, civil society leaders and social innovators — to create strong systems that support healthy, educated people. We help our partners move from knowing their goal to knowing how to reach it. We combine global expertise in health, education and nutrition with analytic rigor, practical support for decision-making and implementation and access to peer problem-solving networks. Together with our partners, we build self-sustaining systems that serve everyone and deliver lasting results. Then we share what we learn so others can achieve results for development, too. For more information, visit our website at: www.r4d.org

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More recently he has worked as an independent consultant in Chad, Cameroon, Central African Republic, Democratic Republic of Congo, Burundi, Togo, Algeria, Ghana and Guinea for international organizations such as the World Bank, IMF, OIF, IDB, UNDP, African Union, UEMOA and BOAD. He has consulted on a range of topics, including development economics, governance, public finances, banking and insurance, natural resource management, agricultural development, and mining and extractive industries.

He has worked in Senegal and abroad as an independent director of a variety of companies, as well as private foundations involved in philanthropy and economic and social research. In addition, he has officiated in international arbitration between states and private companies under national or foreign law. As an international volunteer from 2004 to 2015, he served as a representative of Francophone Borrowing Countries under IDA, a subsidiary of the World Bank. Mr. Loum was also a moderator of the Assises Nationales du Sénégal – Senegal’s National Conference (2008-2010) and vice president of the National Commission for Institutional Reforms (2013-2014).

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Released in Qatar among an audience of education ministers and other education leaders, a new paper from the Results for Development (R4D), “A Moral Obligation, An Economic Priority: The Urgency of Enrolling Out-of-School Children,” investigates the economic costs that six countries bear due to their significant populations of out-of-school children. In addition, the paper reviews the latest literature on the benefits of primary education.

With funding from Sheikha Moza bint Nasser’s Educate A Child initiative, the paper’s authors use two economic methods to estimate the cost of out-of-school children in six countries where the problem is still prevalent: Cote d’Ivoire, Democratic Republic of Congo, India, Mali, Pakistan, and Yemen. The countries were chosen for geographic variety and data availability.

The first method uses labor market data to estimate the total earnings that will be lost in the near future due to young, undereducated workers. Essentially, if today’s out-of-school children do not complete primary education before entering the labor force, their collective future earnings will be less than if they went to school. How much is forfeited depends on the country. In India, which has made great strides in addressing its out-of-school population, the cost is 0.1 percent of GDP. Contrast that with Cote d’Ivoire, where nearly 3 out of 10 children are not expected to complete primary education. It is estimated that if it does not make significant progress toward achieving universal primary education, Cote d’Ivoire will face an income gap equivalent to approximately 7 percent of its GDP when today’s out-of-school children start working. To put this in perspective, in 2008 Cote d’Ivoire invested 0.91 percent of its GDP in health and 4.6 percent in education. With an additional 7 percent of GDP, the country could more than double its annual education and health spending.

The second approach uses a macroeconomic model to project how much higher each country’s economic output would be today if its entire cohort of workers had completed primary school. The loss estimates here are even more dramatic. In Yemen, for instance, where the average worker completes less than 4 years of education, a 38.4 percent income gap is attributable to the out-of-school children of past generations. This second exercise underscores the vast economic returns that could be accrued by investing in remedial education programs for illiterate adults.

R4D Managing Director and report co-author Nicholas Burnett notes that “For the first time, government leaders have the methodology to quantify the consequences of not addressing their populations of out-of-school children. With this data, they can make informed decisions around the crucial issue of where to best invest public spending for long-term growth and development.”

Please click here to read the full paper.

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Ms. Kayumba is the monitoring, evaluation and learning officer for the African Collaborative for Health Financing Solutions (ACS) in Botswana. She provides knowledge management, learning and communications support to the project. In this role, she will support the development and monitoring of ACS project metrics, documentation and measurement activities.

In past roles in her career, Ms. Kayumba led the campaign on localization of aid in the Democratic Republic of Congo (DRC) to promote the role of local actors to better prepare and respond to emergencies. This was done to increase awareness of global commitments by donor agencies and INGOs to recognize and support local capacity for leadership in emergency preparedness. The launch of the campaign supported local actors to understand the key role they play in humanitarian aid in the DRC.

Ms. Kayumba holds a master’s degree in environmental policy from the University of Nairobi and a bachelor’s degree in law from Protestant University in the DRC. She is fluent in French and English.

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For the past 14 years, Mr. Owino has had extensive experience in project management and problem-solving, driving strategy and implementation with an affinity to operational excellence, driving effective data use through technology and system changes as well as process and impact evaluations. In this respect, he demonstrated experience leading and navigating complex conversations with both senior public and private sector leaders, and effectively workshopping technical topics including guidelines to reach consensus, distilling findings into clear and simple, but effective insights and proper documentation.

Some of the projects, he has undertaken include:

• Largescale (national and sub-national) transformations in healthcare in pursuit of sustainable and resilient health financing in HIV/AIDS, family planning (FP), neglected tropical diseases (NTDs), immunization (including polio), malaria and maternal, newborn, and child health (MNCH) – regarding developing, implementing and adapting innovative models in health care.
• Driving impact through building resilient service delivery systems for the future i.e., such as through the social franchised networks, primary health care networks, and community health volunteers networks.
• Private-public partnership in a mixed health system i.e., public private collaborations in healthcare, bridging health facilities and national health insurance agencies contracting gap, and digital health growth strategies.
• Partnership engagement and capacity strengthening i.e. facilitated national capacity building on public financial management and public – private Partnerships (PPP) to regional and local health actors across sub-Saharan Africa (SSA) such as the Ministry of Finance (MOF), Ministry of Health ( MOH), national health insurance agencies, health workers professional bodies, Primary Healthcare facilities, and Local Government Authorities ( LGA).
• Development of social marketing mechanisms of low-cost sexual reproductive health products to drive behavioral change in women, young girls and adolescents.

Mr. Owino holds a Master’s degree in health economics and policy from the University of Nairobi and is a certified public financial management professional. He speaks Swahili, English and French (intermediate).

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Ms. Stewart supports the Primary Health Care Performance Initiative project to enhance PHC measurement—through indicator development, monitoring, evaluation and research—as well as efforts to promote learning and translation of PHC measurement into PHC systems improvement.

Throughout her career, Ms. Stewart has focused on the use of data for decision-making to increase access to public health goods and services. At PATH, Ms. Stewart oversaw the compilation of the first peer-reviewed evidence base for strengthening immunization supply chains—a special edition of Vaccine titled “Building Next-Generation Immunization Supply Chains”—and managed the development of the www.immunizationsupplychains.org website.

Before joining R4D, Ms. Stewart was a senior policy and advocacy officer at PATH, providing strategic advocacy support across a range of priority health areas and interventions and leading monitoring, evaluation, and adaptive management efforts for PATH’s advocacy department. She worked closely with PATH advocates in the Democratic Republic of Congo, Kenya, and Uganda to advance immunization, primary health care and maternal and child health policy outcomes at the national and sub-national levels.

Prior to PATH, Ms. Stewart served as a technical advisor for the USAID | DELIVER PROJECT, collaborating with in-country project staff, Ministry of Health officials, and other stakeholders to increase product availability through increased use of data for decision-making in forecasting, supply planning and supply chain modeling.

Ms. Stewart has a master of arts degree in international development studies from The George Washington University and a BA in political science from Villanova University. She is fluent in English and conversational in Spanish.

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