Chivangue Andes, Kinney Mary V, Stella Damiano, Namburete Denise, George Asha S
N'weti, Maputo, Mozambique.
School of Public Health, Faculty of Community and Health Sciences, University of the Western Cape, Cape Town, Bellville, South Africa.
Glob Health Action. 2025 Dec;18(1):2518651. doi: 10.1080/16549716.2025.2518651. Epub 2025 Jun 26.
Mozambique joined the Global Financing Facility (GFF), a financing mechanism to accelerate progress for women, children, and adolescents' health, with a history of donor dependence, distrust in public finances, and social inequities. Few independent studies have assessed the GFF.
To understand how a global mechanism, such as the GFF, was introduced and utilized in Mozambique.
This qualitative study explored the aid coordination dynamics between 2015 and 2020 linked to the development of the Investment Case (IC) and Project Appraisal Document (PAD), key national GFF planning documents, based on data from 25 documents and 14 qualitative interviews thematically analyzed.
The GFF was not fully understood by stakeholders and initially gained traction in the name of strengthening the health system, ironically amidst prevailing distrust of government systems. Some viewed the IC as consultatively developed, aiding the Ministry of Health in prioritizing issues and convening donors, while others remained sceptical about its impact. The PAD was viewed as a less consultative process, though it engaged the government and partners in setting disbursement-linked indicators (DLIs) to incentivize health system improvements. However, some stakeholders viewed them as unfeasible, while others were excluded by technical discourse. The perceived transparency issues around DLIs fuelled scepticism.
Although the GFF policy processes provided a technically alluring basis for addressing Mozambique's health disparities, respondents revealed nuanced perspectives about how IC and PAD were formulated and followed. Aid coordination reflects various interdependencies, power dynamics, and uncertainties that require active relationship management and long-term institution building.
莫桑比克加入了全球融资机制（GFF），这是一个旨在加速改善妇女、儿童和青少年健康状况的融资机制。该国存在对捐助方的依赖、对公共财政的不信任以及社会不平等的历史。很少有独立研究对全球融资机制进行评估。
了解像全球融资机制这样的全球机制是如何在莫桑比克引入和使用的。
这项定性研究基于对25份文件和14次定性访谈的数据进行主题分析，探讨了2015年至2020年间与投资方案（IC）和项目评估文件（PAD）这两份关键的国家全球融资机制规划文件的制定相关的援助协调动态。
利益相关者并未完全理解全球融资机制，该机制最初以加强卫生系统之名获得关注，具有讽刺意味的是当时人们普遍不信任政府系统。一些人认为投资方案是经过协商制定的，有助于卫生部确定问题优先级并召集捐助方，而另一些人对其影响仍持怀疑态度。项目评估文件被视为一个协商较少的过程，尽管它让政府和合作伙伴参与设定与支付挂钩的指标（DLI）以激励卫生系统改进。然而，一些利益相关者认为这些指标不可行，而另一些人则被技术层面的讨论排除在外。围绕与支付挂钩指标的透明度问题引发了怀疑。
尽管全球融资机制的政策过程为解决莫桑比克的卫生差距提供了一个在技术上颇具吸引力的基础，但受访者对投资方案和项目评估文件的制定及落实情况表达了微妙的观点。援助协调反映了各种相互依存关系、权力动态和不确定性，这需要积极的关系管理和长期的机构建设。
