Implementation ResearchTaking Results-Based Financing from Scheme

to System

Maryam Bigdeli

Third Global Symposium on Health Systems ResearchSatellite meeting – 30 September 2014

Bridging the worlds of research and policy

Call for Expressions of Interest

• Support the development of analytical case studies on RBF and similar initiatives in selected LMICs

• Answer questions on enablers and hindrances in the transition of these types of initiatives from a scheme/project to being fully integrated into the health system

• A multi-country study aimed at drawing cross-cutting lessons on enablers and challenges to scaling-up RBF

• Support from a technical coordinating centre : Bruno Meessen and team at Institute of Tropical Medicine in Antwerp

• Protocol development workshop in October 2014

Our working definitionsResults-Based Financing

Purchasing mechanism that links payments (to producers or consumers) to process or output measures (which may be quantitative or quality measures or a mix of both) that can serve as indicators of, or proxies for, improved health outcomes

Implementation ResearchThe scientific study of the effective delivery of health interventions in diverse settings and within the existing range of health systems.Implementation research goes beyond understanding what is and is not working, to explain also how and why implementation is going right or wrong in that particular setting

Program scale-up:Coverage: geographical, population coverage, servicesSystem integration: institutional arrangements for purchasing function, relationships with health system reforms or financial management reforms etc.Sustainability: ownership, sustainability and institutionalization of verification mechanisms, whether RBF has been made a part of national policy

Research questions

Overarching question:

What are the dynamics (actors and factors) that enable or hinder RBF scale-up decisions and/or implementation?

Sub-questions:• What was the motivation behind the decision to scale up? Who were the drivers,

actors and what were the processes followed?

• To what extent is the scale up of the RBF program being achieved? What are the factors explaining this? What are the key health system and wider government reforms that should be considered?

• Which strategies and processes have been effective in sustaining the scale up and integration of RBF?

• What were the expected, unexpected, positive, and negative consequences of RBF on and beyond the health system, including for example fiscal and governance implications that had to be taken into account during scaling-up?

Selected proposalsTitle PI Organization CountryPBF policy formulation, implementation, and scale up in Rwanda James Humuza National University of Rwanda,

School of Public HealthRwanda

A stakeholder analysis to understand why performance-based financing (PBF) scheme in Chad discontinued

Lamoudi Yonli Research Department of CSSI Chad

Financial and governance reforms during scale-up of PBF in Cameroon Isidore Sieleunou Research for Development International (Cameroon)

Cameroon

Barriers & enabling factors to scale up RBF in Mozambique Joana Falcao Colaboracion Desenvolvimento de Mozambique

Mozambique

Actors and factors in the scaling up of results-based financing in Kenya. Analysis of institutionalism and challenges of a newly- devolved health care system

Erick Otieno Nyambedha

Maseno University Kenya

RBF national roll out in Tanzania: monitoring drivers of policy formulation and early implementation.

Masuma Mamdani Ifakara Health Institute United Republic of Tanzania

Learning from multiple schemes for scale up and sustainability of RBF in Uganda Freddie Ssengooba Makerere University School of Public health

Uganda

Scaling up internal contracting in Cambodia: Lessons and implications for further expansion and integration into the health system

Keovathanak Khim University of Health Sciences Cambodia

Taking Results- Based Financing (RBF) from scheme to system : Burundi Case Study

Eric Bigirimana Bregmans Consulting & Research Burundi

Armenia Results-Based Financing Case Study Akaki Zoidze Curatio International Foundation and Center for Health Services Research and Development at American University of Armenia

Armenia

Pay for Performance in Macedonia: From pilot project, to national reform Vladimir Lazarevik Healthgrouper Macedonia

Rationale for selecting

• Quality of proposals and skills of applicants–reviewed by ITM, AHPSR, WHO HSF, WB

• Scale up achieved vs about to start / in the pipeline• Pilot failed to scale up• Multiple pilots / experiences • Structural challenges to scale (e.g. devolution process

or poor governance• European perspective on pay for performance

experience

Next steps

• Adopt a common view– Different stages of scaling-up (Meessen et al)

– Different approach for each stage-> Brainstorming and protocol workshop

20-24 October 2014 in Antwerp

• Field data collection and analysis – 12 months• Final workshop– Cross-cutting lessons– Common outputs and publications

Adoption(from project to scheme)

Institutionalisation(from scheme to

policy)

Perpetuation(from policy to system)

Questions toMaryam Bigdeli bigdelim@who.intBruno Meessen bmeessen@itg.be

Thank you!