Photos credit: World Bank/Binyam Teshome
PROJECT RATIONALE
Over the last decade, Ethiopia’s health results have improved dramatically, particularly in maternal and child health (MCH). Most notably, under-five child mortality was reduced by two-thirds by 2012, which helped Ethiopia achieve its target for the fourth Millennium Development Goals (MDG) three years ahead of the 2015 deadline. To further accelerate these positive outcomes and accelerate Ethiopia’s MCH progress, the World Bank launched the first Program-for-Results (PforR) operation in June 2013.
RBF AT A GLANCE
RBF Payments
To scale up the coverage of MCH services at the national level and strengthen Ethiopia’s health management information system (HMIS), the PforR operation provides financial incentives based on the achievement and verification of predefined Disbursement Linked Indicators (DLIs).
VERIFICATION
At national level, regular national level population surveys – such as Demographic Health Surveys and Cluster Surveys – are implemented regularly to track performance and ascertain the achievement of results. At the health facility level, facility based surveys such as SPA+ and SARA provide information about the readiness of facilities to provide quality services.
IMPLEMENTATION
Status and Achievements – Fiscal Year 2016
Based on the Ethiopia Mini-Demographic and Health Survey (2014), progress has been relatively consistent with regard to DLIs. For instance, the target for deliveries attended by a skilled birth provider has been met, with coverage increasing from 10 percent in 2011 to 16 percent in 2014 (mini DHS) and further increased to 28 in DHS 2016. Conversely, the 56 percent target for pregnant women receiving at least one antenatal care visit has been exceeded, with coverage increasing from 43 percent in 2011 to 58.5 percent in 2014 and 62% in 2016 DHS. Similarly, the 35 percent target for Contraceptive Prevalence Rate has been exceeded, resulting in a prevalence of 40.4 percent in 2014.
Lessons learned
It is important to maintain continuous policy dialogue: exploring innovation and potential departures from previous policies can help avoid implementation delays and reversals. Further, the assessment of technical assistance needs and their inclusion in program design are critical for effective and efficient implementation. Finally, from the onset, strong partner collaboration and alignment on specific agenda items – such as data quality and results monitoring – have been instrumental to building a working culture focused on results.
EVALUATION AT A GLANCE
The facility survey (Service Provision Assessment Plus (SPA+) was undertaken in 2014 and a Service Availability and Readiness Assessment (SARA) survey undertaken in 2016. The results provided a comprehensive overview of health service delivery in the country. The SPA+ report is now finalized and the results were shared during the Joint Review and Implementation Support mission (April 2015).