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RBF in Afghanistan: Motivation, Design and Preliminary Results
RBF in Afghanistan: Motivation, Design and Preliminary Results
RBF in Afghanistan: Motivation, Design and Preliminary Results
RBF in Afghanistan: Motivation, Design and Preliminary Results
RBF in Afghanistan: Motivation, Design and Preliminary Results
RBF in Afghanistan: Motivation, Design and Preliminary Results
RBF in Afghanistan: Motivation, Design and Preliminary Results
RBF in Afghanistan: Motivation, Design and Preliminary Results
RBF in Afghanistan: Motivation, Design and Preliminary Results
RBF in Afghanistan: Motivation, Design and Preliminary Results
RBF in Afghanistan: Motivation, Design and Preliminary Results
RBF in Afghanistan: Motivation, Design and Preliminary Results
RBF in Afghanistan: Motivation, Design and Preliminary Results
RBF in Afghanistan: Motivation, Design and Preliminary Results
RBF in Afghanistan: Motivation, Design and Preliminary Results
RBF in Afghanistan: Motivation, Design and Preliminary Results
RBF in Afghanistan: Motivation, Design and Preliminary Results
RBF in Afghanistan: Motivation, Design and Preliminary Results
RBF in Afghanistan: Motivation, Design and Preliminary Results
RBF in Afghanistan: Motivation, Design and Preliminary Results
RBF in Afghanistan: Motivation, Design and Preliminary Results
RBF in Afghanistan: Motivation, Design and Preliminary Results
RBF in Afghanistan: Motivation, Design and Preliminary Results
RBF in Afghanistan: Motivation, Design and Preliminary Results
RBF in Afghanistan: Motivation, Design and Preliminary Results
RBF in Afghanistan: Motivation, Design and Preliminary Results
RBF in Afghanistan: Motivation, Design and Preliminary Results
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RBF in Afghanistan: Motivation, Design and Preliminary Results

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This presentation outlines the latest information about RBF's project in Afghanistan RBF, shared with attendees of Women Deliver 2013.

This presentation outlines the latest information about RBF's project in Afghanistan RBF, shared with attendees of Women Deliver 2013.

Published in: Health & Medicine, Business
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  • 1. Results-Based Financing in Afghanistan Motivation, Design, and Preliminary Results Tekabe Belay Senior Economist, South Asia HD, World Bank Women Deliver Kuala Lumpur , Malaysia May 28, 2013
  • 2. Motivation In 2002, the health system was in a very poor condition • Limited capacity in the Ministry of Public Health • 80% of services provided by NGOs • Lack of coordination among stakeholders • Inequitable distribution of health services, with many rural areas extremely under-served • Few functioning health facilities 2
  • 3. Motivation… Reflected in health indicators that were among worst in the world • Life expectancy: women 45 years and men 47 years • Under-five child mortality: 257 deaths per 1,000 live births • Maternal mortality ratio: 1600 per 100,000 live births 3
  • 4. • Focus on stewardship functions o Define the package of services: BPHS and EPHS o Define the beneficiaries: service areas defined for each provider o Define the standard of services: inputs requirements for BPHS and EPHS defined • Partner with the private sector o that has been serving 80% during the conflict • Use its purchasing power effectively to register results • The approach is largely along the lines of current thinking on service delivery in fragile states (e.g. Collier) Strategy: Afghanistan’s Approach to Health Service Delivery 4
  • 5. This achieved impressive results… 5
  • 6. Skilled Birth Attendance - 3 times 6 6.00% 8.40% 18.40% 24.00% 0.00% 5.00% 10.00% 15.00% 20.00% 25.00% 30.00% 2003 2005 2006 2008
  • 7. 7 4.60% 12.60% 30.30% 36.00% 0.00% 5.00% 10.00% 15.00% 20.00% 25.00% 30.00% 35.00% 40.00% 2003 2005 2006 2008 Antenatal Care (>1 ANC) - almost 7 times
  • 8. 8 5.10% 10.40% 15.40% 23.00% 0.00% 5.00% 10.00% 15.00% 20.00% 25.00% 2003 2005 2006 2008 Contraceptive Prevalence Rate – 3.5 times
  • 9. 9 DPT3 Coverage - doubled 21.20% 17.40% 34.60% 43.00% 0.00% 5.00% 10.00% 15.00% 20.00% 25.00% 30.00% 35.00% 40.00% 45.00% 50.00% 2003 2005 2006 2008
  • 10. Infant Mortality - 32% reduction Under 5 Child Mortality – 35% reduction 10 165 257 129 191 111 166 0 50 100 150 200 250 300 Infant Mortality Rate Under 5 Mortality Rate 2001 2006 2008
  • 11. ...but not enough 11 Coverage of important services remains low by global standards e.g. o CPR 15%, o ANC 36% o SBA 24 % Additional effort to increase coverage needed
  • 12. Results-Based Financing (RBF) • Since 2010: o 14 provinces: gradually scaled up o Primary care and hospitals • RBF means: o Payment for additional services o Payments for improved quality o Payments for serving the poor • Rigorously assessed with a gold standard IE design 12
  • 13. Results after 24 Months of Implementation 13
  • 14. ANC: in RBF Facilities 0 15 30 45 60 75 90Numbermonth ANC1-4 Treatment 14
  • 15. ANC 0 15 30 45 60 75 90Numbermonth ANC1-4 Treatment ANC1-4 Control 15
  • 16. PNC: in RBF Facilities 0 15 30 45 60 75 90 Numbermonth PNC1-2 Treatment 16
  • 17. PNC 0 15 30 45 60 75 90 Numbermonth PNC1-2 Treatment PNC1-2 Control 17
  • 18. SBA: in RBF Facilities 0 2 4 6 8 10 12 14 16 18 20 Numbermonth SBA Treatment 18
  • 19. SBA 0 2 4 6 8 10 12 14 16 18 20 Numbermonth SBA Treatment SBA Control 19
  • 20. 0 10 20 30 40 50 60 Numbermoth DPT3 Treatment DPT3: in RBF Facilities 20
  • 21. 0 10 20 30 40 50 60 Numbermoth DPT3 Treatment DPT3 Control DPT3 21
  • 22. RBF Indicators: Changes Between 2010 Q3 and 2012 Q1 21.8 16.5 5.4 1.3 4.3 6 2.6 -0.1 -5 0 5 10 15 20 25 ANC1-4*** PNC1-2*** SBA** DPT3 Treatment Control 22
  • 23. The longer RBF is in place, the better (ANC 1-4) (highest after 12 months ~ control for seasonality) 9.9 13.5 21.8 6.9 1.4 4.3 0 5 10 15 20 25 3months** 12 Months*** 19 months*** Treatment Control 23
  • 24. The longer RBF is in place, the better (PNC 1-2) 3.9 7.7 16.5 3.1 1.5 6 0 2 4 6 8 10 12 14 16 18 3months** 12 Months*** 19 months*** Treatment Control 24
  • 25. The longer RBF is in place, the better (SBA) -0.3 1.2 5.4 0.5 -0.2 2.6 -1 0 1 2 3 4 5 6 3mohths 12 Months 19 months** Treatment Control 25
  • 26. Quality improved in most hospitals with RBF in place 0.0 10.0 20.0 30.0 40.0 50.0 60.0 70.0 80.0 90.0 1 2 3 4 5 6 7 8 9 10 11 12 13 Score Hospitals Overall Score Before After 26
  • 27. Improved Quality 0.0 20.0 40.0 60.0 80.0 100.0 120.0 1 2 3 4 5 6 7 8 9 10 11 12 13 Score Hospitals Hospital Infection prevention Before After 27

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