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Improving quality of care could avert most of the 4.5 million maternal and neonatal deaths and stillbirths that occur each year. The Global Financing Facility (GFF) aims to catalyse the national scale-up of maternal and newborn health (MNH) interventions through focused investments. Achieving impact and value for money requires high, equitable coverage and high quality of interventions. This study examines whether the rhetoric of increasing coverage together with quality has informed investment strategies in MNH through a secondary analysis of 25 GFF documents from 11 African countries. The analysis shows that the country GFF-related documents incorporate some MNH-related quality of care components; however, there is a lack of clarity in what is meant by quality and the absence of core MNH quality of care components as identified by the World Health Organization's MNH quality framework, especially experience of care and newborn care. Many of the Investment Cases have a more diagonal focus on MNH service delivery considering the clinical dimensions of quality, while the investments described in the Project Appraisal Documents are primarily on horizontal structural aspects of the health system strengthening environment. The GFF is at the forefront of investing in MNH globally and provides an important opportunity to explicitly link health systems investments and quality interventions within the MNH continuum of care for optimal impact.

In 2015, Uganda joined the Global Financing Facility (GFF), a Global Health Initiative for Reproductive, Maternal, Newborn, Child, and Adolescent Health (RMNCAH). Similar initiatives have been found to be powerful entities influencing national policy and priorities in Uganda, but few independent studies have assessed the GFF. To understand the policy process and contextual factors in Uganda that influenced the content of the GFF policy documents (Investment Case and Project Appraisal). We conducted a qualitative policy analysis. The data collection included a document review of national RMNCAH policy documents and key informant interviews with national stakeholders involved in the development process of GFF policy documents ( = 16). Data were analyzed thematically using the health policy triangle. The process of developing the GFF documents unfolded rapidly with a strong country-led approach by the government. Work commenced in late 2015; the Investment Case was published in April 2016 and the Project Appraisal Document was completed and presented two months later. The process was steered by technocrats from government agencies, donor agencies, academics and selected civil society organisations, along with the involvement of political figures. The Ministry of Health was at the center of coordinating the process and navigating the contestations between technical priorities and political motivations. Although civil society organisations took part in the process, there were concerns that some were excluded. The learnings from this study provide insights into the translation of globally conceived health initiatives at country level, highlighting enablers and challenges. The study shows the challenges of trying to have a 'country-led' initiative, as such initiatives can still be heavily influenced by 'elites'. Given the diversity of actors with varying interests, achieving representation of key actors, particularly those from underserved groups, can be difficult and may necessitate investing further time and resources in their engagement.

The Global Financing Facility (GFF) was launched in 2015 to catalyse increased domestic and external financing for reproductive, maternal, newborn, child, adolescent health, and nutrition. Half of the deaths along this continuum are neonatal deaths, stillbirths or maternal deaths; yet these topics receive the least aid financing across the continuum. To conduct a policy content analysis of maternal and newborn health (MNH), including stillbirths, in GFF country planning documents, and assess the mortality burden related to the investment. Content analysis was conducted on 24 GFF policy documents, investment cases and project appraisal documents (PADs), from 11 African countries. We used a systematic data extraction approach and applied a framework for analysis considering mindset, measures, and money for MNH interventions and mentions of mortality outcomes. We compared PAD investments to MNH-related deaths by country. For these 11 countries, USD$1,894 million of new funds were allocated through the PADs, including USD$303 million (16%) from GFF. All documents had strong content on MNH, with particular focus on pregnancy and childbirth interventions. The investment cases commonly included comprehensive results frameworks, and PADs generally had less technical content and fewer indicators. Mortality outcomes were mentioned, especially for maternal. Stillbirths were rarely included as targets. Countries had differing approaches to funding descriptions. PAD allocations are commensurate with the burden. The GFF country plans present a promising start in addressing MNH. Emphasising links between investments and burden, explicitly including stillbirth, and highlighting high-impact packages, as appropriate, could potentially increase impact.

The Global Financing Facility (GFF) supports national reproductive, maternal, newborn, child, adolescent health, and nutrition needs. Previous analysis examined how adolescent sexual and reproductive health was represented in GFF national planning documents for 11 GFF partner countries. This paper furthers that analysis for 16 GFF partner countries as part of a Special Series. Content analysis was conducted on publicly available GFF planning documents for Afghanistan, Burkina Faso, Cambodia, CAR, Côte d'Ivoire, Guinea, Haiti, Indonesia, Madagascar, Malawi, Mali, Rwanda, Senegal, Sierra Leone, Tajikistan, Vietnam. Analysis considered adolescent health content (mindset), indicators (measure) and funding (money) relative to adolescent sexual and reproductive health needs, using a tracer indicator.  Countries with higher rates of adolescent pregnancy had more content relating to adolescent reproductive health, with exceptions in fragile contexts. Investment cases had more adolescent content than project appraisal documents. Content gradually weakened from mindset to measures to money. Related conditions, such as fistula, abortion, and mental health, were insufficiently addressed. Documents from Burkina Faso and Malawi demonstrated it is possible to include adolescent programming even within a context of shifting or selective priorities. Tracing prioritisation and translation of commitments into plans provides a foundation for discussing global funding for adolescents. We highlight positive aspects of programming and areas for strengthening and suggest broadening the perspective of adolescent health beyond the reproductive health to encompass issues, such as mental health. This paper forms part of a growing body of accountability literature, supporting advocacy work for adolescent programming and funding.

Community health is key for improving Reproductive, Maternal, Newborn, Child, and Adolescent Health and Nutrition (RMNCAH-N). However, how community health supports integrated RMNCAH-N service delivery in francophone West Africa is under-researched. We examined how six francophone West African countries (Burkina Faso, Côte d'Ivoire, Guinea, Mali, Niger, and Senegal) support community health through the Global Financing Facility for Women, Children and Adolescents (GFF). We conducted a content analysis on Investment Cases and Project Appraisal Documents from selected countries, and set out the scope of the analysis and the key search terms. We applied an iterative hybrid inductive-deductive approach to identify themes for data coding and extraction. The extracted data were compared within and across countries and further grouped into meaningful categories. In country documents, there is a commitment to community health, with significant attention paid to various cadres of community health workers (CHWs) who undertake a range of preventive, promotive and curative roles across RMNCAH-N spectrum. While CHWs renumeration is mentioned, it varies considerably. Most community health indicators focus on CHWs' deliverables, with few related to governance and civil registration. Challenges in implementing community health include poor leadership and governance and resource shortages resulting in low CHWs performance and service utilization. While some countries invest significantly in training CHWs, structural reforms and broader community engagement are lacking. There is an opportunity to better prioritize and streamline community health interventions, including integrating them into health system planning and budgeting, to fully harness their potential to improve RMNCAH-N.

Population supports the need for switching to green power, which is most often understood to mean the use of solar and wind energy. It would be however a mistake to think that solar and wind power plants will solve in full the problem of uninterrupted power supply for all sectors of economy due to the instability of generation modes and the scale of such energy production. Experts suggest that the only possible way to address global energy and environmental issues is further evolution of nuclear power. Nuclear power is not listed explicitly as a national priority project but it is a component of the Science national project and is expected to contribute to the implementation of the Ecology, Education, and International Cooperation and Export projects. In the context of the Ecology project, nuclear power is capable to play a key role in preventing environmental contamination. In the framework of the International Cooperation and Export project, it is possible to export high-technology fast neutron reactors. The experience of interaction with the interested public, and the developed and implemented occupational training programs will provide for the shaping of radiological literacy among young people as part of the Education project.

The Little St. Francis River and its tributaries drain metals-contaminated areas of the Madison County Mines National Priority List Superfund site (MCM) which was designated in 2003 to facilitate remediation of metals contamination within the MCM. One concern for natural resource trustees in the MCM is the potential effects of elevated metals concentrations on the federally threatened St. Francis River crayfish, Faxonius quadruncus, which has a geographic range that is limited to the St. Francis River watershed. A survey of riffle-dwelling crayfish, in-situ cage study, and laboratory toxicity tests were conducted to assess the effects of mining-derived metals on F. quadruncus and other crayfish species in the MCM. Crayfish densities were significantly greater at sites upstream of metals releases from historical mining (henceforth mining releases) compared to densities at sites downstream of mining releases, and metals concentrations in whole-body crayfish, surface water, sediments, macroinvertebrates, fish, and plant material were greater at sites downstream of mining releases compared to sites upstream of mining releases. Crayfish densities were also negatively correlated with consensus-based adverse effects indices, expressed as surface-water toxic units and sediment probable effects quotients. Decreased growth and increased mortality during cage and laboratory studies were likely due to exposure to, and subsequently uptake of, elevated concentrations of metals. Crayfish in all studies were found to bioaccumulate metals, which supports their utility as bioindicators of metals contamination. Study results show that elevated metals concentrations associated with mining releases in the MCM continue to adversely affect biota, including the federally threatened F. quadruncus.

The purpose of this study is to examine the association between financial satisfaction and individuals’ preferences for various national priorities (including economic growth, national defense, freedom of speech, and having a beautiful nation). Using the sixth wave of World Value Survey (2010–2014) data for 60 countries, our Probit regression analyses show a positive and significant relationship between individuals’ financial satisfaction and individuals’ preferences for freedom of speech and having a beautiful nation. We also find that financial satisfaction is negatively associated with the priority of economic growth but not statistically related to the priority of national defense. These findings are robust when we use a Probit model with endogenous regressors and country-level data with a 2SLS estimator. The regression results also show that the preference for a stronger national defense is higher among individuals who are older, married, nationalistic, educated and have jobs in the public sector. Finally, we find that people with lower education and income and those with full-time employment and non-government jobs are more interested in the economic growth of their countries.

This Commentary is part of the Special Issue titled . The Issue examines the Global Financing Facility (GFF) through the lens of nine papers that explore the content and development processes of GFF country documents. While the GFF achieved technical alignment with national reproductive, maternal, newborn, child, and adolescent health priorities, it did not consistently translate into the mobilization of increased domestic resources. Loan-heavy financing structures substituted, rather than supplemented, public spending and intensified fiscal pressure in debt-constrained contexts. The expansion of results-based financing models has brought additional sustainability and equity concerns, with many initiatives collapsing post-project due to inadequate alignment with public finance systems. This falls short of the Lusaka Agenda's strategic shift towards country-led sustainable financing. Stakeholder engagement, particularly in civil society organizations, is often late, limited, or superficial. The neglect of stillbirth and respectful maternity care in the GFF documents calls for a critical look at high impact underprioritized areas when making future GFF investment decisions. As global health aid retracts and low- and middle-income countries navigate debt pressures, global health initiatives must base investments in disease burden data and engage stakeholders meaningfully. To realize the Lusaka Agenda's vision, the GFF must align with national public finance systems and secure sustainability beyond donor cycles.

This commentary examines the learnings from different countries included in the Special Series: . Studies focused on the initial phase of the GFF and highlighted key themes, including power asymmetries, stakeholder engagement, the alignment of funding to health needs, and the treatment of community health and quality of care within GFF-supported programs. This commentary reflects on policy processes and health financing dynamics emerging from the papers in the Special Series and examines what it means for the new strategy in development by the GFF. Ultimately, the GFF remains a promising model for advancing reproductive, maternal, newborn, and child health and nutrition. Realizing its transformative potential, especially with the present context, will require rebalancing technical rigor with political inclusion, and aligning performance metrics with equity-centered accountability.