Health Systems Global

Abstract Background: The Global Financing Facility (GFF) offers an opportunity to close the financing gap that holds back gains in women, children’s and adolescent health is recognised as a key priority by the GFF leadership. However, very little work exists examining GFF practice. As momentum builds for the GFF, we examine the initial efforts of the GFF in addressing adolescent health.Methods: We undertook a content analysis of the first 10 GFF Investment Cases and Project Appraisal Documents available on the GFF website. The countries involved include Bangladesh, Cameroon, Democratic Republic of Congo, Ethiopia, Guatemala, Kenya, Liberia, Mozambique, Nigeria, Tanzania and Uganda. Results: While several country documents signal understanding and investment in adolescent health as a strategic area, this is not consistent across all countries, nor between Investment Cases and Project Appraisal Documents. In both types of documents commitments weaken as one moves from programming content to indicators to investment. Important contributions include how teenage pregnancy is a universal concern, how adolescent and youth friendly health services and school-based programs are supported in several country documents, how gender is noted as a key social determinant critical for mainstreaming across the health system, alongside the importance of multi-sectoral collaboration, and the acknowledgement of adolescent rights. Weaknesses include the lack of comprehensive analysis of adolescent health needs, inconsistent investments in adolescent friendly health services and school based programs, missed opportunities in not supporting multi-component and multi-level initiatives to change gender norms involving adolescent boys in addition to adolescent girls, and neglect of governance approaches to broker effective multi-sectoral collaboration, community engagement and adolescent involvement. Conclusion: There are important examples of how the GFF supports adolescent health as a priority area. However, more can be done. While building on service delivery approaches more consistently, it must also fund initiatives that address the main social and systems drivers of adolescent health. This requires capacity building for the technical aspects of adolescent health, but also engaging politically to ensure that the right actors are convened to prioritize adolescent health in country plans and to ensure accountability in the GFF process itself.

The collection of biomarker-based indicators of adult health is an important addition to socioeconomic surveys since they can provide valuable insights into the biological functions, and the complex causal pathways between socioeconomic environments and health outcomes. We document the collection of blood-plasma based biomarkers as a pilot project within the Malawi Longitudinal Study of Families and Health (MLSFH). Using the LabAnywhere system as a minimally-invasive approach previously not used in less-developed countries, we collected biomarkers of lipids, metabolic processes, organ function, and the immune system. Overall, only small proportions of the collected samples are above the upper limits of the normal clinical ranges as defined by western standards. The correlational patterns between the biomarkers are consistent with observations from developed countries and the comparison with other low-income populations shows remarkably similar age-specific patterns of the biomarkers despite differences in the mode of blood sampling. The present study confirms that the collection of biomarker-based indicators of adult health using the LabAnywhere system is feasible in rural sub-Saharan contexts and this approach provides an attractive alternative to the collection of dried blood spots (DBS) and venous blood samples. Iliana V. KOHLER, Researcher and Associate Director, Population Aging Research Center, and Population Studies Center, University of Pennsylvania, 3718 Locust Walk, Philadelphia, PA 19104, USA. E-mail: iliana@pop.upenn.edu . Philip ANGLEWCZ, Assistant Professor, School of Public Health & Tropical Medicine and Department of Global Health System and Development, 1440 Canal St., Suite 2200, New Orleans, LA 70112-2737, USA. E-mail: panglewi@tulane.edu . Hans-Peter KOHLER, Frederick J.\ Warren Professor of Demography and Professor in Sociology, Department of Sociology and Population Studies Center, University of Pennsylvania, 3718 Locust Walk, Philadelphia, PA 19104-6299, USA;. E-mail: hpkohler@pop.upenn.edu . John F. McCABE, Programmer/Data Analyst, Population Aging Research Center (PARC), University of Pennsylvania, 3718 Locust Walk, Philadelphia, PA 19104, USA. E-mail: mccabef@pop.upenn.edu . Ben CHILIMA, Director, Community Health Sciences Unit, Ministry of Health and Population Community Health Sciences Unit, Private Bag 65, Lilonge, Malawi. E-mail: bchilima2@yahoo.com . Beth J. SOLDO, Distinguished Senior Scholar in Sociology, University of Pennsylvania, 3718 Locust Walk, Philadelphia, PA 19104, USA. E-mail: bsoldo@pop.upen.edu