Results-Based Aid: The Salud Mesoamérica Experience
The Salud Mesoamérica Initiative (SMI) is a public-private partnership between the Bill & Melinda Gates Foundation (BMGF), the Carlos Slim Foundation, the Government of Spain, the Inter-American Development Bank (IDB), the countries of Central America and the State of Chiapas in Mexico. SMI works to reduce maternal and health inequalities through a results-based financing model, aligned with priorities established by the governments of the region. Among the poor in Mesoamerica, only 5 out of every 10 pregnant women are attended during childbirth by skilled birth personnel and the mortality rate among children in poverty is twice that of the national average.
The SMI Results-Based Financing (RBF) model is based on four basic concepts: 1) Countries have to work within the poorest 20% of their populations, selected based on Poverty Incidence Data; 2) SMI funds can only finance evidence-based, cost-effective and promising interventions for maternal and child health; 3) All projects are co-financed by SMI and countries (50% average cost-sharing, leveraging domestic funding) and executed under the RBF model; and 4) All results are externally verified by an independent third party (Institute of Health Metrics and Evaluation) through both household and health facility surveys. If countries meet 80% of their goals they receive 50% of their original investment to use freely within the health sector.
In 24 months teams have modified service delivery platforms, achieved changes in national norms, and attained permanent availability of life-saving medicines and equipment in the hardest-to-reach areas of Mesoamerica in the first phase of the program. The next phase will include coverage and quality indicators. In the region, SMI interventions are directly benefiting 1.8 million women of reproductive age and children less than 5 years of age. Indirectly, 4.5 million people living in the poorest areas are also benefiting from these interventions.
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