Scaling-Up Results for Maternal, Newborn and Child Health

1. Scaling-Up Results forMaternal, Newborn and Child Health June 3, 2014

2. Definition • Results-Based Financing (RBF) is a cash payment or nonmonetary transfer made to a national or sub-national government, manager, provider, payer or consumer of health services after predefined results have been attained and verified. • RBFis an umbrella term that encompasses various types of interventions that target beneficiaries (for example, conditional cash transfers), providers (for example, performance-based financing), and country governments (for example, cash on delivery).

3. Diversity of RBF Interventions Incentives primarily for: COD/P4R Countries & Organizations Nigeria, Ethiopia Community Primary Secondary PBF PBC “PRP”* Providers Rwanda , Burundi OBA Afghanistan BurkinaFaso, Gambia, Nigeria CCT/Vouchers Beneficiaries Type of Reward: *Provider Recognition Programs Payment based on FFS Other monetary payments Non-monetary rewards

13. Phase 1: building a solid foundation • US$550 from Norway and DFID with $1.9 Billion in IDA financing supporting 32 countries • Highlights: • Change from inputs to focus on results for MCH • Shift from input to results, good design and implementation support leads to better results • Evidence building through rigorous evaluations • High country demand • Link to IDA: $1 of Trust Fund: $4 IDA

14. Strong focus on achieving MCH results

15. RBF has become the main form of World Bank health financing Africa Region All Bank

16. Burundi: A Common Platform for all Development Partners to Support a Single Government Plan

17. Results

18. Rwanda: Increased Coverage and Quality of Care

19. Argentina: neonatal mortality reduced by 74% • Intervention: • National to province: Per Capita Payment based on enrollment of eligible population • Province to public clinics: contracting of providers on fee for service basis • Incentives formula incorporate use and quality of MCH services as well as some health outcome indicators • Key Results: • Provided 4.7 million pregnant women and children with health coverage • Reduced the probability of low birth weight by 19% • Reduced the probability of in-hospital neonatal death by 74 % • Highly Cost Effective intervention • Use a small amount to leverage existing resources (2%-4% of provincial public spending on health) • Cost of DALY saved was $1,115 (compared to GDP/cap of $6,075)

20. Increasing utilization of essential MCH health services

21. Burundi: Improved quality of care and greater equity Overall quality score (%)

22. Zimbabwe: strengthening referral system

23. Zambia: getting better value for money

24. Support to Country Teams

25. Support to Country Teams • Capacity building and TA on RBF & IE • Bank staff and Country counterparts • To ensure informed decision making on RBF design and to support implementation • Quality assurance throughout project cycle • At concept, appraisal, board approval stage, QERs, MTRs • Continuous knowledge sharing and learning • Across countries • In country

26. Technical support to improve RBF Verification of Results: key for viability and sustainability of RBF approaches • No one-size fits all Verification case studies show many ways to design and implement verification depending on variety of factors Quality of Care: RBF can be a tool in quality improvement policies Challenges to continue to improve, to measure and verify quality of care: Many countries pioneering and experimenting

27. Cross-country learning: 2014 Results and Impact Evaluation Workshop for RBF

28. Global Hub of RBF Knowledge www.rbfhealth.org All Things RBF blog Tools for practitioners IE and PBF toolkits Case Studies Country experience videos Publications News Regular engagement with key audiences; key for website traffic Engaging global south, beneficiaries, and health workers Increasing PPT shelf life and audience Listening and engaging influencers

29. Building the Evidence

30. Analytical Work and Evaluation at HRITF • Objective: • Capture a diversity of lessons and insights on RBF through rich set of evaluations and analytical methods • Learning on impact is absolutely necessary • Rigorous evidence remains thin: need impact measurement • Learning on impact, however, is also not enough • Temporal and methodological limitations of IEs to understand why, how RBF works • More to answer: • contextual and implementation factors, process, cost and sustainability

31. Comprehensive Learning at HRITF • Many opportunities to learn Experience Theory Exploratory study IE Baseline IE Follow-up Monitoring, implementation case studies, topical analyses Documentation

32. Diversity of Themes

33. Phase 2 – Scaling-Up to Accelerate Impact

34. Scale-Up Plan • Expand and deepen reach • target vulnerable populations, expand package of services focusing on nutrition and neonatal care, strengthen quality of care • Leverage public and private sector • Build partnerships with development partners • Address health systems bottlenecks • Supply chain, Human Resources for Health, Information systems • Build in financial sustainability

35. Financing the Scale-Up • An additional US$510 million in Trust Fund funding • US$2.8 Billion in IDA funding • In country co-financing from partners: GAVI, Global Fund and UNICEF • Increased Domestic contributions • For example Republic of Congo (US$100 million) • Integrating in national financing strategies for health

36. Scale-Up will accelerate impact towards MDG4 and 5 • In 2014-2015 RBF programs will save the lives of 10 thousand mothers, 111 thousand newborns, and 185 thousand under-five children. • Scale-up will save an additional 61 thousand mothers, 560 thousand newborns and 1.1 million under-five children between 2016–2020. • Scale-up will enable access for an additional 300 million people.

37. Additional 71,000 Women and 1.3 m Children lives saved until 2020

38. Additional 671,000 newborn lives saved until 2020

39. Thank you