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Perspectives on Performance Based Financing within the GAVI Alliance

Perspectives on Performance Based Financing within the GAVI Alliance. Peter Hansen. Clermont-Ferrand , 11 May 2011. Performance Based Financing (PBF) within the GAVI Alliance. Operates on two main levels: Between GAVI and national government (‘aid’): Immunisation Services Support (ISS)

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Perspectives on Performance Based Financing within the GAVI Alliance

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  1. Perspectives on Performance Based Financing within the GAVI Alliance Peter Hansen Clermont-Ferrand, 11 May 2011

  2. Performance Based Financing (PBF) within the GAVI Alliance • Operates on two main levels: • Between GAVI and national government (‘aid’): Immunisation Services Support (ISS) • Between national government and lower levels, civil society and communities (‘financing’): Health Systems Strengthening • Future directions • Grant monitoring framework • Health Systems Funding Platform • Incentives for Routine Immunisation Strengthening (IRIS)

  3. Draft Grant Monitoring Framework

  4. Health Systems Funding Platform • ‘Financing’ – platform to be used to finance PBF initiatives within many countries, based on national health strategies • ‘Aid’ – options/modalities are in development • Options to be explored to deliver all cash based programmes within GAVI through platform

  5. IRIS • Objectives • Increase routine immunisation coverage • Increase equity in immunisation coverage • Structure • National governments submit applications to GAVI • Must specify detailed plan describing how incentives would be pushed down to lower levels of the system

  6. IRIS • Builds on ISS design and lessons learned • Key Changes • Incentives distributed to lower levels of system • Portion of grant “fixed” (process measures) and portion “at risk” (outcome measures) each year • Performance payments linked to coverage (and possibly equity) rather than number of children immunised • Enhanced and independent validation of results, linked to WHO/UNICEF estimates

  7. Payments under IRIS – hypothetical example

  8. What has worked in using PBF within GAVI? • PBF has helped catalyse achievement of better results in many countries • Positive feedback from countries • Clarity, flexibility, autonomy, ownership, encourages innovation, low transaction costs and reporting burden • Reduced transaction costs at global level • Leaner model means more money to finance results at country level • ISS pathfinder effect

  9. Lessonslearned • If incentives are wrong, potential to distort behaviour • Be explicit about theory of change and put it to the test • Actively identify and document unintended consequences • Need to ensure appropriate balance between: • Data integrity, country ownership and capacity strengthening • Quantitative rules and responsiveness to context • Predictability and results orientation • Rewarding good performance and addressing needs of low performers

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