Salud Mesoamérica 2015 Initiative

Building  Evidence  on  Results-­‐Based  Financing  for  Health:  3rd  Annual  Impact  Evalua>on  Workshop  

Bangkok,  Thailand  

October  17-­‐21,  2011.  

“In Mesoamerica, inequality measures 6 centimeters. This is the difference in the average height at five years of age, between a poor child in the region, and a child whose parents belong to the richest quintile.”

Luis Alberto Moreno IDB President

What  is  SM2015?  

  SM2015:  Innova4ve  Public-­‐Private  Partnership    •  Bill  &  Melinda  Gates  Founda1on    •  Ins>tuto  Carlos  Slim  de  la  Salud    •  AECID  •  8  Mesoamerican  Countries  •  IDB    (jointly  implements  with  countries)  

•  Funds  for  the  Region:  US$  142m  

•  RBF  model  targeted  to  poorest  areas  

•  Working  with  countries  to  find  innova4ve  ways  to  bring  quality  healthcare  to  hard  to  reach  communi4es  

•  Cataly4c  actor  aligned  with  regional  work  in  the  health  sector

Why  the  Poorest  20%?  

SM2015  Municipali4es  are  

in  Red  

Why  Mesoamérica?  

Source: Tristao. I. Perfiles de los países Mesoamericanos. IDB Working paper 2010

 Objec4ve:  

 Reduce  heath  inequali>es  by  extending  coverage  and  improving  quality  of  interven>ons  

 Specifically:    

  Increase  the  supply,  quality  and  use  of  evidence  based  public  health  interven>ons  in  the  poorest  20%  

  Contribute  to  the  poli>cal  and  financial  commitment  within  the  Mesoamerican  Region  to  close  the  health  equity  gap  

   Increase  the  availability  and  use  of  evidence  for  pro-­‐poor  health  policies  

Salud Mesoamérica 2015

Theory  of  Change  

Increase  in  the  demand  for  services  among  the  poorest  

popula>ons  

Increased  availability  and  use  of  evidence  for  pro-­‐poor  policies  and  norms  

Increased  alloca4on  of  health  resources  to  the  poorest  popula>ons  

Increase  in  the    supply  of  quality  

services  among  the  poor  

Reduce  the  neonatal,  child  and  maternal  mortality  and  morbidity  in  

the  target  popula>on  

Scale-­‐up  the  effec4ve  coverage  of  evidence  based  interven>ons  

(SM2015  Donors,  IDB,  Countries,  Supply  and  Demand)  New  incen4ves  within  the  RBF  model  

  Focus on results in the poorest populations •  Unmet Basic Needs, Geographic Targeting

  Packages of integrated services with proven efficacy   Areas:

•  Maternal-Child Health •  Nutrition •  Immunization •  Malaria •  Dengue

  Policy Dialogue   Monitoring, Learning and Evaluation

SM2015:  Key  Elements  

Results Based Financing

TI  CN  

Project  Budget:  Funding  from  SM2015  (IT)  +  Funding  from  Country (CN)  

SM2015  reimburses    country  50%  of  its  CN  funding    if  targets  are  met  to  be  used  in  

the  Health  Sector  

  Contract  between  IDB  and  Countries  

  Results  Based  Disbursements  

  Predetermined  targets  for  the  targeted  area  

  External  Verifica>on  •  Households  and  Health  Centers  

Innova4ve  Results  Based  Financing  Model    •  2-­‐3  Country  Opera>ons  of  18  months  •  2  Strike  Policy    

5  Year  Performance  Tranche    SM2015  Country  Opera>on  funds  are  divided  into    

3  opera>ons  of  18  months    

1st  Opera>on  and  Goals  

2nd  Opera>on  and  Goals  

3rd  Opera>on  and  Goals  

Salud  Mesoamérica  2015  

Baseline  t=0  

Follow-­‐up  t=18  months  

Follow-­‐up  t=36  months  

Follow-­‐up  t=54  months  

Where  you  are    

Where  you  want  to  go  

Key  Performance  Framework  Indicators:  Nutri4on  Example  

  Payment  indicator  at  54  months:  reduce  anemia  in  children  6-­‐23  months  of  age  

  Payment  Indicator  at  36  months:  increase  coverage  of  micronutrient    powders  in  households  (%  of  children  6-­‐23  months  of  age  with  completed  micronutrient  regiment)  

  Payment  indicator  at  18  months:  increase  availability  of  key  inputs  including  zinc,  ORS  and  micronutrients  at  health  centers  

SM2015  Monitoring  and  Evalua4on  Objec4ves  

  Monitoring  during  implementa>on  

o  Dashboards:  Are  we  on  track  to  meet  our  targets?  

  Target  Verifica>on  

o  External  Household  and  facility  Surveys:  Did  we  meet  our  targets?  

  Impact  Evalua>on    

o  Effects  of  SM2015  RBF  model  

o  Experimental  and  quasi-­‐experimental  evalua1ons  

o  Effects  of  demand  and  supply  side  incen1ves    

o  Experimental  evalua1ons  

  Learning:  How/why  did  we  meet  our  targets?  

Evalua4on  of  Na4onal,  Sub-­‐na4onal  and  Local  level  RBF  Strategies    

Regional  and  Na>onal  

SM2015  Performance  Incen>ves  (50%  of  

Counterpart  Funding  ):  

Incen>ves  

Incen>ves+  

Resources  

Sub-­‐na>onal  

Fee  for  service  at  sub-­‐na>onal  

level    

Performance  Incen>ves  to  department/districts/HMOs    for  quality  and  coverage  goals  

Local    Supply:  Incen>ves  to  health  centers,  CHWs,  

TBAs,  for  mee>ng  quality  and  coverage  goals  

Demand:  CCTs  to  mothers,  communi>es