Salud Mesoamérica 2015 Initiative
Building Evidence on Results-‐Based Financing for Health: 3rd Annual Impact Evalua>on Workshop
Bangkok, Thailand
October 17-‐21, 2011.
“In Mesoamerica, inequality measures 6 centimeters. This is the difference in the average height at five years of age, between a poor child in the region, and a child whose parents belong to the richest quintile.”
Luis Alberto Moreno IDB President
What is SM2015?
SM2015: Innova4ve Public-‐Private Partnership • Bill & Melinda Gates Founda1on • Ins>tuto Carlos Slim de la Salud • AECID • 8 Mesoamerican Countries • IDB (jointly implements with countries)
• Funds for the Region: US$ 142m
• RBF model targeted to poorest areas
• Working with countries to find innova4ve ways to bring quality healthcare to hard to reach communi4es
• Cataly4c actor aligned with regional work in the health sector
Why the Poorest 20%?
SM2015 Municipali4es are
in Red
Why Mesoamérica?
Source: Tristao. I. Perfiles de los países Mesoamericanos. IDB Working paper 2010
Objec4ve:
Reduce heath inequali>es by extending coverage and improving quality of interven>ons
Specifically:
Increase the supply, quality and use of evidence based public health interven>ons in the poorest 20%
Contribute to the poli>cal and financial commitment within the Mesoamerican Region to close the health equity gap
Increase the availability and use of evidence for pro-‐poor health policies
Salud Mesoamérica 2015
Theory of Change
Increase in the demand for services among the poorest
popula>ons
Increased availability and use of evidence for pro-‐poor policies and norms
Increased alloca4on of health resources to the poorest popula>ons
Increase in the supply of quality
services among the poor
Reduce the neonatal, child and maternal mortality and morbidity in
the target popula>on
Scale-‐up the effec4ve coverage of evidence based interven>ons
(SM2015 Donors, IDB, Countries, Supply and Demand) New incen4ves within the RBF model
Focus on results in the poorest populations • Unmet Basic Needs, Geographic Targeting
Packages of integrated services with proven efficacy Areas:
• Maternal-Child Health • Nutrition • Immunization • Malaria • Dengue
Policy Dialogue Monitoring, Learning and Evaluation
SM2015: Key Elements
Results Based Financing
TI CN
Project Budget: Funding from SM2015 (IT) + Funding from Country (CN)
SM2015 reimburses country 50% of its CN funding if targets are met to be used in
the Health Sector
Contract between IDB and Countries
Results Based Disbursements
Predetermined targets for the targeted area
External Verifica>on • Households and Health Centers
Innova4ve Results Based Financing Model • 2-‐3 Country Opera>ons of 18 months • 2 Strike Policy
5 Year Performance Tranche SM2015 Country Opera>on funds are divided into
3 opera>ons of 18 months
1st Opera>on and Goals
2nd Opera>on and Goals
3rd Opera>on and Goals
Salud Mesoamérica 2015
Baseline t=0
Follow-‐up t=18 months
Follow-‐up t=36 months
Follow-‐up t=54 months
Where you are
Where you want to go
Key Performance Framework Indicators: Nutri4on Example
Payment indicator at 54 months: reduce anemia in children 6-‐23 months of age
Payment Indicator at 36 months: increase coverage of micronutrient powders in households (% of children 6-‐23 months of age with completed micronutrient regiment)
Payment indicator at 18 months: increase availability of key inputs including zinc, ORS and micronutrients at health centers
SM2015 Monitoring and Evalua4on Objec4ves
Monitoring during implementa>on
o Dashboards: Are we on track to meet our targets?
Target Verifica>on
o External Household and facility Surveys: Did we meet our targets?
Impact Evalua>on
o Effects of SM2015 RBF model
o Experimental and quasi-‐experimental evalua1ons
o Effects of demand and supply side incen1ves
o Experimental evalua1ons
Learning: How/why did we meet our targets?
Evalua4on of Na4onal, Sub-‐na4onal and Local level RBF Strategies
Regional and Na>onal
SM2015 Performance Incen>ves (50% of
Counterpart Funding ):
Incen>ves
Incen>ves+
Resources
Sub-‐na>onal
Fee for service at sub-‐na>onal
level
Performance Incen>ves to department/districts/HMOs for quality and coverage goals
Local Supply: Incen>ves to health centers, CHWs,
TBAs, for mee>ng quality and coverage goals
Demand: CCTs to mothers, communi>es