HRITF US$ 11 million and IDA US$ 32.8 million (original project IDA US$ 23.8 + additional financing IDA US$ 10)
Objective of the Project:
The first project development objective is to increase the coverage of quality maternal, neonatal and child health care services in 8 health districts (roughly a quarter of the population). The second objective is to strengthen the institutional capacity of the Ministry of Health.
The objective of the RBF is to strengthen supply with a focus on quality and utilization (equity) of health services (specifically maternal and child services), through quarterly payments to health facilities based on achieved results. Contracts exist between MoH and all public and private not for profit health centers and hospitals in the 8 pilot health districts. Payment is on fee-for-service basis (16 indicators for primary care and 2 for hospital care) focused on maternal and child health and malaria free health care (4 indicators) with adjustments based on quality of care. The HRITF grant supports 8 pilot health districts (out of 34). Payments take place after verification for quality and quantity. Internal and external verification takes place every three months. The internal verification is done by district health teams, and the external verification by “district controllers”, provided by an international RBF firm, and Community Based Organizations. Half facilities have autonomy to decide how to use the RBF payments. In addition to improving the quality of maternal and neonatal care (MNH) and other services for the whole population, the Health System Performance Project also aims to enhance the utilization of these services by the poorest, by providing an additional incentive to health providers for treating the poor.
GAVI, Global Fund. The three partners harmonized their fiduciary procedures and use the same RBF features (indicators, control and verification rules, etc…). GAVI funds RBF implementation in 4 districts and GF in 17 districts
Impact Evaluation Summary:
The objective of the IE is measuring the impact of RBF on health outcomes and understanding the factors driving this impact. In the current design of the IE of the RBFpilot in Benin, a combination of two interventions is tested: RBF “conditional rewards” (credits linked to results achieved by health centers) versus “unconditional” rewards (credits not linked to results achieved); management autonomy versus no management autonomy. In addition to health outcomes, the impact evaluation will focus on the effect of RBF on financial equity of maternal and child health. It will also evaluate whether managerial autonomy is a driver of the impact of RBF on maternal and child health outcomes. Benin uses an experimental design and quantitative as well as qualitative methods for the evaluation. Research questions include: (i) measuring the impact of RBF on health outcomes, quality of care and equity; (ii) understanding the factors driving this impact: RBF versus lump sum, increased management autonomy; (iii) the effect of management autonomy on the impact of RBF; (iv) the relation between RBF and health workers’ motivation; and (v) the relation between RBF and health workers’ corruption (vi) the impact of RBF on health care seeking behaviors. Read more