Norwegian Involvement in RBF

Ingvar Theo Olsen, Norad
Agenda


1. World Bank Trust Fund HRIG
2. Bilateral MDG 4 and 5 program m e
3. GAVI
4. Global Fund for AIDS, TB and Malari...
Results-based financing can be used at any level but it
                     must trickle down to the point of contact bet...
World Bank Multi Donor Trust Fund
    Health Result Innovation Grant


•    Established in 2007, focusing on MDG 4, 5 and ...
W orld B a nk           Afghanistan                          Eritrea
H R IG
                        • Health system barely...
W orld B a nk           Rwanda                                  Zambia
H R IG
                        • One of the highest...
RBF in the Norwegian bilateral MDG 4&5 initiative:
•   Initiative by Prime Minister Jens Stoltenberg to contribute towards...
Tanzania (NTPI)
P ro blem :
    MMR 578/1 00,000 live births, high newborn MR
    Low percentage of assisted births (  hea...
... Tanzania (NTPI)


•   Owned by MOHSW, funds channelled through SWAp basket
    arrangem ent
•   Monthly reporting dire...
India (NIPI)
Problem:
   High m aternal-and newborn m ortality, low share delivering in
   health centres/hospitals ( ajor...
India (NIPI)
•   NIPI supports NRHM in 5 states with 60% of India’s under five
    m ortality
•   NIPI offers flexible fin...
Pakistan (NPPI)
 P ro blem :
 • High m aternal-and newborn m ortality, poor quality and access to
     health services res...
Pakistan (NPPI)
 •   Sindh province – 1 0 rural districts
 •   Strategic and catalytic support to achieve MDG 4&5
 •   Via...
GAVI
                       G A V I boa rd
                                                                     T he V a c...
GAVI ISS - (Result based Aid)
•   N o rw eg ia n s uppo rt N O K 500 m illio n per yea r
•   A pplic a tio n ba s ed
     ...
Results
•   36 o f 51 c ountries w ith a ppro ved a pplic a tio ns qua lified fo r
    rew a rds
•   Qualification dependi...
Conclusion: Findings from the evaluation could not conclude that the
  positive results can be attributed to the result ba...
GFATM - RBF
•   Norwegian support 2008: NOK 375 m illion
•   Application based ( reviewed by independent panel and approve...
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Ingvar Theo Olsen - Norwegian Involvement in RBF

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Ingvar Theo Olsen - Norwegian Involvement in RBF

  1. 1. Norwegian Involvement in RBF Ingvar Theo Olsen, Norad
  2. 2. Agenda 1. World Bank Trust Fund HRIG 2. Bilateral MDG 4 and 5 program m e 3. GAVI 4. Global Fund for AIDS, TB and Malaria ( GFATM) 1 5.01 .09 Side/Page 2
  3. 3. Results-based financing can be used at any level but it must trickle down to the point of contact between the provider and household to impact results D ono r s N a tiona l G o vernm ent S ub- na tiona l Results Based Aid R eg ion/D is tr ic t Results Based Budgeting and Financing Results Based Financing CCP, CCT, RB Providers Households bonuses Health Centers or Individuals Side/Page 3 Hospitals 1 5.01 .09
  4. 4. World Bank Multi Donor Trust Fund Health Result Innovation Grant • Established in 2007, focusing on MDG 4, 5 and 1 c • Im prove health results through strengthening health system s • Explore value of RBF as a tool • Norwegian support NOK 580 m illion over 5 years • Norway so far the only donor, AUSAID interested 1 5.01 .09 Side/Page 4
  5. 5. W orld B a nk Afghanistan Eritrea H R IG • Health system barely functioning - Under utilization of reproductive and Problem/ context after Taliban child health services • Govt started contracting with NGOs to deliver basic package of health care Supply side Contracting to NGOs: Performance incentives for: • Performance-linked bonus to • Regional health authorities for MCH deliver basic package of health targets • MOH based on national MCH targets services • Complementary bonus for hospitals for maternal and child services • Incentives for pregnant women (transp., Demand side food in del. waiting rooms, etc.) • Fin. incentives for immunization, growth monitoring, check-ups, absence of FGM • Ann. lottery for those fulfilling the above 1 5.01 .09 Side/Page 5
  6. 6. W orld B a nk Rwanda Zambia H R IG • One of the highest rates of IMR • Progress on reducing IMR/U5MR slow, Problem/ and U5MR MMR increasing context • Current RBF program on supply- • Coverage low due to human resources, side, limited impact on deliveries, absenteeism, etc. and barriers to not covering demand utilization • Incentives for female health Target based performance incentives for Supply side workers to work in rural areas DHMT, facility teams, CHW, TBAs • Incentives for pregnant w. to use • League table competition for Comm. Demand side MCH Health Committees non-financial • Community incentives to do awards • Combined transport subsidy and non- interventions for MDG4, incl. family planning financial incentives to promote inst. deliveries and post-natal visits 1 5.01 .09 Side/Page 6
  7. 7. RBF in the Norwegian bilateral MDG 4&5 initiative: • Initiative by Prime Minister Jens Stoltenberg to contribute towards the millennium development goals for health • Global efforts – Global Leaders’ Network – Sherpa group • Country efforts in 4-5 countries based on potentials for major impact on MDG 4 & 5: Tanzania: Sector Wide Apporach programme (SWAp) with Government and DPs India: Support to National Rural Health Mission (NRHM) in five states Pakistan: Support to 10 districts in a province in the North Nigeria: Support to programmes in 3-4 states in North, channelled through DFID 1 5.01 .09 Side/Page 7
  8. 8. Tanzania (NTPI) P ro blem : MMR 578/1 00,000 live births, high newborn MR Low percentage of assisted births ( health facility) Poor quality services, poorly m otivated staff S upply s ide R B F • Bonuses for health facilities ( health workers)at different levels for (dispensary, health centres, hospitals, CHMT, RHMT) • Based on achievem ents at institution på m åloppnåelse for institusjonen • National universal targets for five indicators: OPV 0, DPT 3, IPT 2, facility deliveries, HMIS com plete and subm itted in tim e O bjec tive: To m otivate health workers to im prove quality of services related to m aternal and child health in order to attract m ore pregnant wom en 1 5.01 .09 Side/Page 8
  9. 9. ... Tanzania (NTPI) • Owned by MOHSW, funds channelled through SWAp basket arrangem ent • Monthly reporting directly to president Kikwete • Full national rollout without pilot! • Many actors/stakeholders in the SWAp and basket • Different com ponents ( training, m anagem ent, data validation, HMIS strengthening, process evaluation, im pact evaluation) • Final phases of program m e developm ent – im plem entation starting 1 5.01 .09 Side/Page 9
  10. 10. India (NIPI) Problem: High m aternal-and newborn m ortality, low share delivering in health centres/hospitals ( ajor changes taking place) m ... Supply side (NIPI) • Bonus for voluntary fem ale health workers with low training (ASHA og YASHODA) • Focus on infant and child health ( well as m aternal) as Demand side (NRHM) : • Cash incentives for wom en to deliver in facilities ( etc.) Objective: • To m otivate voluntary health workers to im prove quality and follow- up of m aternal-and child health services • Encourage wom en to utilize health services 1 5.01 .09 Side/Page 1 0
  11. 11. India (NIPI) • NIPI supports NRHM in 5 states with 60% of India’s under five m ortality • NIPI offers flexible financing – m oney that can be used in catalytic, strategic or innovative ways • The funds are channelled through thre UN agencies: UNOPS, UNICEF & WHO • RBF m uch used in NRHM: – supply and dem and based – Institutional deliveries – PPP – engaging obstetrics – Im prove health services for infants ( NIPI – Yashoda and ASHA) • Need for form al evaluations 1 5.01 .09 Side/Page 1 1
  12. 12. Pakistan (NPPI) P ro blem : • High m aternal-and newborn m ortality, poor quality and access to health services resulting in low utilization rates S upply s ide R B F: • Increased access to MCH services through result based contracts (PPPs) • Im proved governance and result based m anagem ent D em a nd s ide: • Incentives/vouchers to pregnant wom en to deliver at facility O bjec tives : • Im prove em powerm ent of wom en ( increase awareness/choice re own health) • Increase access to and quality of MNCH services • Increase adm inistrative capacity and quality of health care system s 1 5.01 .09 Side/Page 1 2
  13. 13. Pakistan (NPPI) • Sindh province – 1 0 rural districts • Strategic and catalytic support to achieve MDG 4&5 • Via UN (”One UN” country) • RBF schem e to increase access, quality, dem and for im proved MNCH services • Voucher initiative: – rem ove econom ic barriers – pilot and eventually scale- up • How can perverse incentives be avoided – anti corruption, good governance and m gt capacity – Strengthen HMIS, evaluation m echanism s and research 1 5.01 .09 Side/Page 1 3
  14. 14. GAVI G A V I boa rd T he V a c c ine Fund (M ultila tera l, bila tera le do no rs , res ea rc h ins t., fund raising, advocacy, va c c ine indus try, c ivil s oc iety) additional resources to countries I ndependent Immu R eview C o m m ittee niza tio N ew S a fety H ea lth review of country proposals, n monitoring reports va c c in s uppli s ys te S ys te es es ms m (I S S ) P ro po s a ls Technical support - from partners M o nitoring (WHO, UNICEF R eports etc.) National systems Preparing applications, implementation, monitoring and evaluation 1 5.01 .09 Side/Page 1 4
  15. 15. GAVI ISS - (Result based Aid) • N o rw eg ia n s uppo rt N O K 500 m illio n per yea r • A pplic a tio n ba s ed – Countries with GDP per capita below US$1 000 are eligible for ISS funding from GAVI in a five year perspective ( R es ult-ba s ed A id) i.e. • I nves tm ent – The two first years a country receives support as an investm ent calculated as num ber of additional children to be vaccinated, with baseline current year • R ew a rds – The third year countries receive support based on actual achievem ents – $20 per additional vaccinated child over the baseline in the application • R es ult indic a to r – # children > 1 year that have been vaccinated with DPT3 • E x terna l va lida tio n o f da ta – Validation of data through Data Quality Audits ( DQA)carried out by audit firm s 1 5.01 .09 Side/Page 1 5
  16. 16. Results • 36 o f 51 c ountries w ith a ppro ved a pplic a tio ns qua lified fo r rew a rds • Qualification depending on: – achievem ents re num ber of children vaccinated – that country reports on results are accepted in an external data validation test • Most of the countries that did not receive the reward did not pass the data quality test, whereas others did not vaccinate enough children • V a c c ina tio n c o vera g e m ea s ured by D T P 3 in G A V I c o untries ha s inc rea s ed – DTP3 – from 64% to 71 % • P o verty o rienta tio n a nd reduc ed inequities – poor countries and countries with poor coverage have received a larger proportion of GAVI funds – urban/rural inequity has been reduced – 1 5.01 .09 inequities have been reduced Side/Page 1 6 gender
  17. 17. Conclusion: Findings from the evaluation could not conclude that the positive results can be attributed to the result based aspects of the GAVI ISS – Flexibility of funds m ay in itself be attributable – Countries with good results had strong partners that provided sound technical support, etc. – Population growth in itself was the basis for the m ajor share of the num ber of children vaccinated Latest: Recent Lancet article by Chris Murray indicates data fraud with routine data reporting for GAVI ISS. Survey data model indicates over reporting from countries, linking this to result based financing. 1 5.01 .09 Side/Page 1 7
  18. 18. GFATM - RBF • Norwegian support 2008: NOK 375 m illion • Application based ( reviewed by independent panel and approved by Board) • Support for 2 years – followed by phase 2 application ( total 5 years) • Local Fund Agent ( audit firm )reviews and validates invoices intl. and report the results back to GFATM • Results end in recom m endation to the Board: ”go”, ”conditional go”, ”no go” • The system is basically flexible, based on local conditions, the harm onization agenda and existing best practices 1 5.01 .09 Side/Page 1 8

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