Interview with Angela Gichaga, CEO of Financing Alliance for Health
Article published in Ticino Magazine
You are a very successful manager (now CEO of Financing Alliance for Health. Would you like to tell us which milestones of your professional and personal life have had the most influence on your choice to commit to health?
«My parents were civil servants, and my mother worked in the health sector. I grew up believing that government drives development and has a reach and relevance in every corner of a country more significant than any entity. As a result, this motivated me to serve in government. Because of my mother’s influence in the health sector, I was drawn to helping people by alleviating suffering. When I joined the government as a doctor, I was posted in Garbartulla by the government to serve in both rural and hardship areas.
While working there, I recognized that one, the healthcare system and infrastructure needed to be improved to meet the community’s needs due to poor physical, social, and financial access challenges. Secondly, we needed to extend care to the household level. One of the milestones and experiences while working in Garbartulla health facility was I had the opportunity to serve a nomadic community that used to pass by the facility and seek help. However, they moved with their cattle during this period, and we had dismal health metrics. As a result, we partnered with community health workers to follow the nomadic community as they searched for pasture and water for their animals. Through this assistance, we were able to equip and empower community health workers to be able to offer services as they moved around with the community and to be able to record the health impact we were having. This experience changed my mindset about how we think and deliver health services in Africa. It also raised awareness on how to re-orient the health care system so that we can extend care at the point and place of need».
When did you first come into contact with philanthropy?
«My first encounter with philanthropy was when I was working for the government, and we had philanthropic partners who would come to support the delivery of government priorities. They did this in many ways. First, they would help co-implementers working alongside the government to do many things and be innovative, which differed from the government’s comparative advantage at the time. When these implementors could demonstrate that an intervention would work or have an impact, they would make the case to us who are in government. As such, we explored feasible opportunities to scale interventions through the government. The second opportunity was around filling some of the gaps in service delivery; the government has significant financial and human resources but also has competing priorities. There were more urgent needs that the government could only sometimes respond to adequately or promptly. Therefore, philanthropy’s role when I was in government was around being able to mobilize, step in and step up to fill some of the need gaps that arose.
Over time, my understanding, visibility, and engagement in philanthropy have continued to grow and evolve and have become central to some of our work at the Financing Alliance for Health. As an entity, we collaborate with philanthropic partners to support our activities. More importantly, we facilitate engagement between philanthropy partners, governments, and other stakeholders so we can take advantage of diverse funding pipelines. FAH believes that money from the government, private sector, philanthropy, and social sector has different comparative advantages that can be leveraged. These funding sources are great for sustaining and scaling interventions and meeting running costs. Private sector money is excellent for areas where innovation is critical, or efficiency is a priority. Philanthropy and social sector money is vital in supporting discovery and innovation in low risks and filling the gaps of reach that will not necessarily make economic sense for the private sector or may go delayed if waiting on the public sector. I continue to see the value that philanthropy plays in these different areas».
What is the Financing Alliance for Health (FAH), what is the structure and objectives of your organization?
«The Financing Alliance for Health (FAH) is an Africa-based, African-led, and Africa-focused entity that convenes governments, funders, philanthropy, private-sector, and communities to address systemic financing challenges to scaling primary and community health systems for delivery of integrated primary healthcare services through country, regional and global partnerships. As trusted strategic and technical advisors, FAH acts as a bridge between the world of health and finance through long-term partnering with the Ministries of Health and Ministries of Finance teams to develop different and changing financing sources. This approach empowers /enables them to be the lead stewards in their local health systems to reach the scale and sustainability that is needed and ultimately achieve universal health coverage. Headquartered in Nairobi, Kenya, FAH has successfully supported 17 national and sub-national governments across 12 countries (Rwanda, Zambia, Zimbabwe, Haiti, Burkina Faso, Uganda, Sierra Leone, Liberia, South Africa, Malawi, Kenya, Togo)».
What projects is your organization currently pursuing?
«FAH works with governments in their journey to build, finance, and scale their primary and community health programs. We seek to strengthen national health systems through embedding teams and regional health systems through evidence generation, designing financing solutions, and advocacy. We ensure that country experiences are elevated globally, and global best practices are contextualized locally.
At the country level, FAH has focused on catalyzing health policy formulation processes, providing Technical Assistance (TA) to host governments, supporting capacity building of government teams and other stakeholders on health financing.
In 2023, we are currently supporting 2 countries (Kenya; 6 sub-national governments and Zambia). We are working to partner with 3 more countries Ghana, Botswana and Senegal.
Our current service offering to these countries include:
- Political prioritization: supporting Primary & Community Health teams in developing and identifying champions, making a case for investment, and supporting advocacy efforts;
- Strategy and policy development: developing costed strategies and supportive policies as well as running iterative costing processes;
- Development of investment plan(s): advising the government on alternative financing and fiscal scenarios;
- Resource mapping and mobilization: identifying and prioritizing funding sources, analyzing financing gaps and resource needs, and developing financing pathway(s). This also includes developing financing solutions (mechanisms, products, or approaches) that the governments can tap into to narrow their funding gaps.
We continue to dream big and advance our big ideas toward closing the community health financing gap, which is currently estimated at $4.4 billion. We have made remarkable progress with the Africa Frontline First Initiative (AFF), our front-runner idea that will get us one step closer to bringing this gap down to zero.
AFF is a collaborative initiative that supports the financing and strengthening of integrated and sustainable community health service delivery to achieve health for all. Through unique partnerships between governments, donors, implementers and technical allies, AFF will institutionalize and scale 200,000 professionalized community health workers (CHWs) across 10 African countries by 2030.
As the originator and seed investor in the ideation of the Africa Frontline First Initiative, FAH continues to co-lead the successful implementation of this tri-phased approach, while still serving as fiscal sponsor of the overall initiative. From our experience, investment and implementation excellence are strongly linked: therefore, the Africa Frontline First initiative will continue to be a key anchor of our work as we transform the financing and operational excellence of integrated community health systems in Africa alongside ecosystem partners».
How many philanthropists are you working with at the moment and from which countries do they come?
«Financing Alliance for Health (FAH) is privileged to have received support from extraordinary partners in the last five years. We are currently working with 5 renowned philanthropies namely; the Community Health Acceleration Partnership (CHAP), Skoll Foundation, Johnson & Johnson Foundation, Elma Philanthropies, and LGT Ventures Philanthropy. These Philanthropies originate from the Global North countries».
Could you explain how you work with philanthropists from the selection of suitable profiles to the concrete realization of projects?
«FAH works with philanthropies that espouse and aligns with our values:
- Respect and trust are the basis of our relationships;
- We challenge and disrupt the status quo for impact;
- We are curious, passionate, and effective in our approach;
- We are driven to support the well-being of communities.
As we work with philanthropies – FAH aligns stakeholders towards a shared vision: one where the country’s investments catalyze additional funding from public and private sector partners. Through partnering with philanthropies FAH seeks to:
- Align multiple stakeholders towards a common vision;
- Co-develop effective primary & community health strategies and less fragmented modalities to finance them;
- Advocate for prioritization and more effective financing.Build the health financing capabilities of government and global health stakeholders to ensure evidence-based resource allocation».
Would you give us an example of a particularly successful collaboration with a philanthropist?
«In 2022, the Financing Alliance for Health was one of the five organizations to win the prestigious 2022 Skoll Award for Social Innovation. The Skoll Foundation is known for its incredibly thorough due diligence, and they verified that we are on a path to create as much human impact as the best organizations in the world. Beyond this incredible boost of assurance, it’s a great honor and an equally great responsibility that was bestowed on us. This award signals that the work of bringing healthcare closer to communities matters.
Additionally, it recognizes that with the right mix of public, private and philanthropic funding options, governments who are the stewards of the public health system can and will continue to invest in strong community health systems as a scalable and sustainable pathway to achieving universal health coverage.
Further, it underscores the incredibly important work of community health workers who are communities’ first line of defense against death, disease and pandemics. It’s a huge responsibility because it means that FAH’s work to narrow the ~$4.4B funding gap for community health must continue in earnest. We are energized by this responsibility and continue with a laser focus towards expanding our footprint and to serving African governments in their quest to ensure #health4all»
What do you think philanthropists can do for health that institutions cannot?
«There are strong arguments in favor of Philanthropists participating in the discussion of health care reform. The total amount of philanthropy resources is hardly a rounding error in terms of government spending. Hence, Philanthropies cannot exclusively rely on the work they carry out through their grants in order to have a lasting influence. The ability to influence or persuade others must be put to the test. Government is the key player in health. As a result, Philanthropists need to work to influence policymaking and direct government funding toward their goals».
Your vision for the future of philanthropy?
«My vision for philanthropy is multifold. First, that competition would become the new collaboration. Many philanthropies have priority areas, and the challenge becomes where there is a narrow focus on a niche that philanthropies influence implementors, governments, and co-implementors to focus on areas that do not strengthen the whole system. My vision for philanthropy is that they would balance the particular focus on areas of interest with actual system change support so that we maintain both the system that delivers on interventions. My second vision is that philanthropy would come together and harmonize how they work to reduce funding flow fragmentation, which increases the efficiency and effectiveness of the dollars flowing into the system. This will help philanthropy partners leverage and collaborate as opposed to competing to get a return on investment. Thirdly, philanthropy will be able to de-risk the private sector entry into development areas. The private sector has a role to play in the following: health, education, agriculture, and among others so that the return on the investment is sustainable and less optimal to the private sector players willing to commit financially. Philanthropic money can be used to de-risk their innovations and offer some form of grace period for the private sector to explore, research, and bring solutions to the force. My fourth vision is that countries would align their national priorities and policies and work alongside other sources of donor funding, especially bilateral and multilateral money, in a blended financing way so that there is a grace period for the government to be able to implement their programs and be able to see their ROI. Another vision is that philanthropy would be able to increase not just the amounts but the duration of funding that they give to implementors and also move more towards unrestricted funding. This funding will be accounted for, and the implementors and proximate leaders will have passed through a trusted due diligence process. This will help them to be more responsive to emerging needs that had not been envisioned earlier».