Your SlideShare is downloading. ×
  • Like
Rbf afghanistan women deliver
Upcoming SlideShare
Loading in...5
×

Thanks for flagging this SlideShare!

Oops! An error has occurred.

×

Now you can save presentations on your phone or tablet

Available for both IPhone and Android

Text the download link to your phone

Standard text messaging rates apply

Rbf afghanistan women deliver

  • 726 views
Published

 

  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
    Be the first to comment
    Be the first to like this
No Downloads

Views

Total Views
726
On SlideShare
0
From Embeds
0
Number of Embeds
3

Actions

Shares
Downloads
20
Comments
0
Likes
0

Embeds 0

No embeds

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
    No notes for slide

Transcript

  • 1. Results-Based Financingin AfghanistanMotivation, Design, and Preliminary ResultsTekabe BelaySenior Economist, South Asia HD, World BankWomen DeliverKuala Lumpur , MalaysiaMay 28, 2013
  • 2. MotivationIn 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 ruralareas extremely under-served• Few functioning health facilities2
  • 3. Motivation…Reflected in health indicators that were among worst inthe 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 births3
  • 4. • Focus on stewardship functionso Define the package of services: BPHS and EPHSo Define the beneficiaries: service areas defined for each providero Define the standard of services: inputs requirements for BPHS and EPHSdefined• Partner with the private sectoro 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 onservice delivery in fragile states (e.g. Collier)Strategy: Afghanistan’s Approach toHealth Service Delivery4
  • 5. This achievedimpressive results…5
  • 6. Skilled Birth Attendance - 3 times66.00%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. 74.60%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 2008Antenatal Care (>1 ANC) - almost 7 times
  • 8. 85.10%10.40%15.40%23.00%0.00%5.00%10.00%15.00%20.00%25.00%2003 2005 2006 2008Contraceptive Prevalence Rate – 3.5 times
  • 9. 9DPT3 Coverage - doubled21.20%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% reductionUnder 5 Child Mortality – 35% reduction10165257129191111166050100150200250300Infant Mortality Rate Under 5 Mortality Rate200120062008
  • 11. ...but not enough11Coverage of important services remains low byglobal 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 upo Primary care and hospitals• RBF means:o Payment for additional serviceso Payments for improved qualityo Payments for serving the poor• Rigorously assessed with a gold standard IE design12
  • 13. Results after 24 Months ofImplementation13
  • 14. ANC: in RBF Facilities0153045607590NumbermonthANC1-4 Treatment14
  • 15. ANC0153045607590NumbermonthANC1-4 Treatment ANC1-4 Control15
  • 16. PNC: in RBF Facilities0153045607590NumbermonthPNC1-2 Treatment16
  • 17. PNC0153045607590NumbermonthPNC1-2 Treatment PNC1-2 Control17
  • 18. SBA: in RBF Facilities02468101214161820NumbermonthSBA Treatment18
  • 19. SBA02468101214161820NumbermonthSBA Treatment SBA Control19
  • 20. 0102030405060NumbermothDPT3 TreatmentDPT3: in RBF Facilities20
  • 21. 0102030405060NumbermothDPT3 Treatment DPT3 ControlDPT321
  • 22. RBF Indicators: Changes Between2010 Q3 and 2012 Q121.816.55.41.34.362.6-0.1-50510152025ANC1-4*** PNC1-2*** SBA** DPT3TreatmentControl22
  • 23. The longer RBF is in place, the better(ANC 1-4)(highest after 12 months ~ control for seasonality)9.913.521.86.91.44.305101520253months** 12 Months*** 19 months***TreatmentControl23
  • 24. The longer RBF is in place, the better(PNC 1-2)3.97.716.53.11.560246810121416183months** 12 Months*** 19 months***TreatmentControl24
  • 25. The longer RBF is in place, the better(SBA)-0.31.25.40.5-0.22.6-101234563mohths 12 Months 19 months**TreatmentControl25
  • 26. Quality improved in most hospitalswith RBF in place0.010.020.030.040.050.060.070.080.090.01 2 3 4 5 6 7 8 9 10 11 12 13ScoreHospitalsOverall ScoreBeforeAfter26
  • 27. Improved Quality0.020.040.060.080.0100.0120.01 2 3 4 5 6 7 8 9 10 11 12 13ScoreHospitalsHospital Infection preventionBeforeAfter27