During a workshop supported by the Health Results Innovation Trust fund (HRITF) last week in Istanbul, 14 countries that are piloting or scaling up results-based financing projects came together to present the initial results from their country programs, learn from each other’s experiences and find solutions for the challenges.
As someone who started working on an RBF project in 2007, in Zambia, I was encouraged to be in a meeting of practitioners sharing results just five years later. I remember vividly my frustration with input-based approaches in 2007, and the sense of urgency I felt about the limited progress and the need for more and higher quality services. Pregnant with my daughter and spending time visiting rural health facilities, I sat in a design workshop organized by the Ministry of Health and development partners, listening intently as Harrison Mkandawire, a district manager from Katete in eastern Zambia, shared his experience of introducing a results-based approach in his district. As Mkandawire spoke, I realized that linking payments to results brings a cultural change in the system and that results-based approaches presented the best opportunity to accelerate progress on child and maternal health in developing countries. Focusing on results and making the results transparent could also make the system more accountable to its end users.
At the workshop in Istanbul, I was encouraged as seven countries presented operational data showing various levels of improvements in the coverage of maternal and child health services. Many countries showed a keen interest to strengthen ways to learn during implementation, using quantitative and qualitative evaluation methods. Going forward, and with three years to the MDG deadline, this approach is important to support implementation of the programs, as well as improve the available evidence of the factors leading to the success or failure of a program.
A key challenge highlighted by many country representatives is the issue of financial sustainability. In his recent article in the WHO Bulletin, Joe Kutzin also highlights the importance of integrating financing for RBF countries in the wider health sector financial strategy, and explores how universal health coverage can be used as an entry point.
As I continue my work in my new role as Manager of the HRITF, I am excited we are now in a phase of the program with many projects in the field and a real opportunity to learn what works and what needs to be done differently. This blog will be a platform to share country experiences, discuss technical challenges and link the RBF experience and approach to the wider debate on global health policy.
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