Sign up for the RBF Bulletin and get the latest information on programs, research and events!
OSLO, December 11, 2013 -- Countries and major donors are changing the way they finance maternal and child, malaria, tuberculosis and HIV/AIDS health programs in low-income countries to increase their impact.
UN Secretary General Ban Ki-moon, whose multi stakeholder partnership, Every Woman Every Child, is sparking important gains, says: “Innovative approaches to financing are urgently required to meet the health needs of the world’s women and children. Results-based financing can improve the quality and efficiency of services and, just as important, enhance equity.”
-- In Tanzania, 24-hour staffing for birthing clinics where poorly paid staff were working only for a few hours.
-- In Burundi, over just one year, births at health facilities rose by 25 percent, prenatal consultations went up by 20 percent and the number of children fully vaccinated increased by 10 percent.
-- In Argentina, a 74 percent decline in neonatal mortality.
-- In India, an increase from 700,000 to 12 million women using clinics and hospitals to deliver babies.
The need to set better incentives
In Tanzania, His Excellency Jakaya Mrisho Kikwete, President of the United Republic of Tanzania has long been a champion for maternal, newborn and child health.
The pay for performance program in Tanzania focused on maternal and child health. The program shifted health workers’ focus from routine service provision to a results oriented focus. This led to increased institutional delivery and other MNCH indicators. The incentives provided were used to address bottlenecks in service delivery including motivating health workers and reducing drug shortages.
"Reporting significantly improved in quality and timeliness, and therefore strengthened accountability," reports Hussein Ali Mwinyi, M.D., Minister for Health and Social Welfare. "The results of the program were two fold - strengthened health systems and improved health outputs."
In Argentina, the two-tier RBF program paid provinces for the enrollment of poor women and children in health insurance, and for the achievement of health outcomes such as infants born at healthy birth weights. Providers were paid on a fee-for-service basis for mostly preventative maternal and child health services.
The results were "quite dramatic," reports Paul Gertler, Ph.D., Professor of Economics at the University of California Berkeley who led the evaluation of Argentina's plan. The assessment found a 32 percent reduction in stillbirths, a 23 percent reduction in low birth weight babies, and a 74 percent reduction in hospital neonatal mortality for RBF program service users. The statistics were all confirmed by examining 300,000 birth certificates, a much larger sample than available ever before for other RBF evaluations.