Results-Based Financing
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Results-Based Financing

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What is RBF?. Results-based financing (RBF) Pay-for-performance (P4P). Provision of payment for the attainment of well-defined results. Transfer of money or material goods conditional on taking a measureable action or achieving a predetermined performance target (CGD, 2009). . Donor Central govern
Results-Based Financing

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1. Results-Based Financing An Overview

2. What is RBF?

3. What is RBF?

4. What is RBF? People are motivated by intrinsic forces (professional pride) People are motivated by extrinsic forces (money and recognition) If designed well, RBF can reinforce professional pride with money and recognition, without undermining intrinsic motivation

5. Why RBF?

6. Why RBF? Development Assistance Perspective

7. Why RBF? Development Assistance Perspective

8. Why RBF? Development Assistance Perspective

9. Why RBF? Development Assistance Perspective

10. Why RBF?

11. Why RBF? Country Perspective Argentina: Plan Nacer

12. Why RBF? Country Perspective

13. Why RBF? Country Perspective

14. Why RBF? Country Perspective

15. Why RBF? Country Perspective

16. Why RBF? Country perspective

17. RBF in practice

18. RBF Challenges

19. RBF Challenges

20. Does RBF work? Conditional Cash Transfers (CCTs) rigorously evaluated Bulk of evidence from Latin American and Caribbean countries; some encouraging evidence from Bangladesh, Cambodia Effective in reducing poverty in the short term Substantial increases in use of health services, primarily preventive services Impact on outcomes mixed Typically require complementary supply-side actions

21. Does RBF work? Supply side: generally weak designs Argentina: increased enrollment of poor, previously uninsured women and children Afghanistan and Cambodia: increases in immunization, prenatal visits, overall service use, equity gains Many confounding factors (increased financing, TA, feedback, supervision, training, etc.) make it difficult to isolate effect of ?incentive?

22. Does RBF work? Rwanda: performance bonus scheme Prospective, quasi-experimental design Effect of incentives was ?isolated? from effect of additional resources Equal amount of resources without the incentives would not have achieved the same outcomes Improved child health outcomes: height for age, morbidity

23. Does RBF work? Less impact on demand-sensitive interventions (ANC) Rwanda now piloting community-based performance bonus to increase demand Government adopting culture of results ? moving RBF to Education and other sectors

24. Does RBF work? Little information on ?why? demand and supply schemes succeed or fail Insufficient information on unintended consequences Sound monitoring, documentation and evaluation of new initiatives will be critical

25. What?s next?

26. World Bank Health Results Innovation Trust Fund Eight grants linked to IDA credits to finance the national strategy (International Health Partnership + principles) with focus on MDGs 4 and 5 Why linked to IDA credits? Integrates RBF into broader policy dialogue between MOF and MOH Engages Bank operational staff at country level and headquarters Embeds RBF into Bank support for HSS Potentially leverages additional IDA for health $95 million from Norway supports comprehensive design, implementation, monitoring and impact evaluation Support INTERESTED gov?ts ? ready to take on RBF Experience of linking RBF to IDA has highlighted important issues ? benefits of how to structure Ownership --- link with MOF RBF as complement to other investments in HSS ? fit into national strategy Operational presence --- gov?ts request a lot of TA, appreciate making the link with MOF, bringing in other country experiences IDA and the RBF grant aligned Estimate that grants leveraged additional IDA for health $first 55 million leveraged $45 million IDA Support INTERESTED gov?ts ? ready to take on RBF Experience of linking RBF to IDA has highlighted important issues ? benefits of how to structure Ownership --- link with MOF RBF as complement to other investments in HSS ? fit into national strategy Operational presence --- gov?ts request a lot of TA, appreciate making the link with MOF, bringing in other country experiences IDA and the RBF grant aligned Estimate that grants leveraged additional IDA for health $first 55 million leveraged $45 million IDA

27. The WB Health Results Innovation Trust Fund Why not IHP+ countries? Gov?t needs to own RBF ? not all IHP+ countries ready or interested to do RBF We let country demand determine pool ? then since limited resources, we selected among interested countries on competitive basis. Why not IHP+ countries? Gov?t needs to own RBF ? not all IHP+ countries ready or interested to do RBF We let country demand determine pool ? then since limited resources, we selected among interested countries on competitive basis.

28. Characteristics of Selected RBF Trust Fund Projects Afghanistan: performance-based bonus payments to NGOs DR Congo: performance-based bonus payments to public facilities and health workers Eritrea: demand-side incentives to mothers and performance budgets to administrative levels Rwanda: performance-based contracting with community organizations to increase demand Zambia: performance-based bonuses to public facilities and district Because this is designed by the gov?t based on national strategy, their own analysis of constraints, their culture, their systems ?. Each RBF is different. Because this is designed by the gov?t based on national strategy, their own analysis of constraints, their culture, their systems ?. Each RBF is different.

30. Conclusions RBF is appealing to governments Motivation and creativity to strengthen health systems Flexibility to engage all providers (public, private, NGO) Culture of results - replacing focus on inputs Facilitates targeting ? at poorest, MDG 4/5

31. Conclusions Both demand and supply side matter ? and must be balanced RBF not panacea! ? must be part of broader dialogue with Ministries of Health and Finance and linked to investments in health Still building evidence base but exciting potential Accelerate progress toward MDGs Implement Paris/Accra Principles ? align with the International Health Partnership


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