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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