Transforming Health Systems Through Results Based Financing

Learning from Implementation & Impact Evaluations

Dinesh Nair, Sr Health Specialist

Making an impact around the world

An expanding RBF Portfolio

FY09 FY10 FY11 FY12 FY13 FY14 FY15 FY16 FY17 FY18 FY19 FY20 -

50

100

150

200

250

300

350

400

450

79

160 121

177 175

249 263 321

361

285

148

60

4

11

12

24 41

63

105

105 105

50

13

5

IDA HRITF

Disb

urse

men

ts, U

S$ m

illio

n

Note: Fiscal Year is July 1 through June 30. Projections for FY15-FY20 are based on total commitments and the expected closing date of the projects.

36 projects

Early Evidence of Impact

Rwanda: Increasing Coverage and Quality

5

Improving Efficiency in Zambia &

Zimbabwe

6

Using Operational Data

Operational data informs operations and learning

• To monitor progress and assess RBF’s contributions to health system’s goals

• To monitor what money is spent on • To identify areas for further inquiries and mid-course

corrections• To assess the effects of RBF approaches• To facilitate cross-country learning and sharing of

experience

The dashboards show real time performance and amount spent, down to the facility level.

Learning from Implementation

12

Evaluating RBFPrograms

Growth of the IE portfolio

• 36 impact evaluations + 5 in pipeline• 5 program assessments including 3 completed• High increase in overall number = many at design stage• Impact evaluations also progressing to final stage• Endline surveys planned for 2014: Zambia, Zimbabwe

Diversity of ThemesIntervention evaluated Countries Supply-side RBF payments Afghanistan, Argentina, Armenia, Benin, Burkina Faso, Burundi,

Cameroon, Central African Republic, Democratic Republic of Congo, Djibouti, Ethiopia, Gambia, Haiti, Kenya, Kyrgyz Republic, Lao PDR, Lesotho, Liberia, Nigeria, Pakistan, Rwanda, Senegal, Sierra Leone, Tajikistan, Turkey, Yemen, Zambia, Zimbabwe

Demand-side RBF payments Gambia, Lao PDR, Nigeria, Pakistan, Rwanda, Senegal, Yemen, Zimbabwe

Community-Based RBF Gambia, Haiti, India, Senegal, RwandaRBF for quality of care Afghanistan, Argentina, Benin, Brazil, Cambodia, Cameroon,

Central African Republic, China, Haiti, Kyrgyz Republic, Lao PDR, Nigeria, Senegal, Tajikistan, Turkey, Zambia, Zimbabwe

RBF in hospitals Afghanistan, Argentina, Burundi, China, India, Kyrgyz Republic, Lao PDR, Liberia, Nigeria, Philippines, Senegal, Sierra Leone, Turkey

Additional financing Benin, Nigeria, Zambia, Zimbabwe Differential incentive levels Central African Republic, ChinaEnhanced monitoring and supervision

Cameroon, Kyrgyz Republic

RBF and training of providers ZimbabweProcess vs. output BrazilNegative Incentives (sanctions) Turkey

15

Innovations

Supply Chain

Quality of Care

Community & Demand Side RBF

Knowledge Sharing & Capacity Building

Scale Up

THANK YOU