RBF Impact Evaluation MeetingTunis, TunisiaOctober 18-22, 2010

MDGs(Long Term Impact)

Examples

Policy Approach Demand side requirement Supply side requirement

4.1 Reduce by 2/3 child mortality rate

5.1 Reduce by ¾maternal mortality ratio

Detect and treat high risk pregnancies

Mom accesses health care early in pregnancy

Health care provider delivers appropriate care

Promote skilled/in-facility deliveries

Mom delivers baby in a health facility

Health care providers follow clinical guidelines

Dependent on behavior

Input based development models

• Provide more resources

• Purchase more:

• Buildings, staff, equipment, training, etc

Output/outcome based development models

• Incentivize more and better use of existing resources

• Payments conditional on:

• Utilization of health services

• Quality of health service delivery

• Final health outcomes

Supply and Demand Incentives

Supply Side

• Monetary transfers to service providers (i.e. clinics, physicians and staff, CHWs) based on:

• More services

• Higher quality services

• Final outcomes

Demand Side

• Monetary or in-kind transfers to households (usually mothers) conditional on compliance with health care requirements or outcomes:

• Attending antenatal care visits

• Attending well-baby care visits

• In-facility births

Results Based Financing (RBF) is seen as a highly promising tool to: improve health service delivery

strengthen health systems

improve governance and transparency

accelerate progress towards health MDGs

What is the impact of RBF on: Health care provision?

▪ Ex. quality of health care

Utilization of Services?▪ Ex. Number of prenatal care visits

Maternal and child health outcomes?▪ Ex. Height and weight of children

Are impacts sustainable?

Are there unintended consequences of RBF?

How does RBF work differently in different contexts: Population characteristics: age, gender, poverty, urban Provider characteristics : public/private, autonomy, capacity

Are impacts cost-effective relative to other interventions?

Governments and implementing agencies face enormous design and implementation challenges Common operational questions raised by

governments and RBF counterparts around the world

Need to know not only if RBF works, but also how to make it work efficiently Project monitoring and documentation allow us to

form hypothesis

Impact evaluation allows us to test the hypothesis

Examples What are the right incentives?

Who should be incentivized?

How to reduce reporting errors and corruption?

What are the optimal provider capabilities?

What are the key organizational building blocks to make RBF work?

What components of the RBF “package” matter most: contracting mechanism? money? decentralized decision making or autonomy? improved monitoring and supervision? better data and information?

Impact of Countries

Supply side RBF payments to service providers

Afghanistan, Benin, DRC, Eritrea, Ghana, Kyrgyz Republic, Rwanda, Zambia

Linking RBF payments to quality of care Afghanistan, Benin, Ghana, Kyrgyz Republic, Zambia

Differential incentive levels Ghana, Zambia

Additional monitoring and supervision Kyrgyz Republic

Demand side RBF payments to beneficiaries

Eritrea, Ghana and Rwanda

Strengthen the evidence base for Health Results Based Financing HRITF: 9 countries (Afghanistan, Benin, DRC, Eritrea, Ghana, Kyrgyz,

Rwanda, Zambia, Zimbabwe) and growing…. SIEF: 5 countries (Argentina, Benin, China, India, Rwanda)

Provide technical assistance for: Design of rigorous, prospective impact evaluations of RBF projects Common measurement & survey instruments across countries Common approach to data collection and data management

Promote community of practice in HRBF IE Regular meetings and workshops

Disseminate lessons learned from IE work

Tailored technical assistance from IE Network: Evaluation design Results Chain Data collection and quality control Costing and cost-effectiveness Qualitative research Data analysis (Stata)

Cross-country knowledge sharing

Each team sets priorities for the week Develop topic(s) throughout the week Presentation on Friday

Agenda….

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