Rbf afghanistan women deliver

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Rbf afghanistan women deliver

  1. 1. Results-Based Financingin AfghanistanMotivation, Design, and Preliminary ResultsTekabe BelaySenior Economist, South Asia HD, World BankWomen DeliverKuala Lumpur , MalaysiaMay 28, 2013
  2. 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. 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. 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. 5. This achievedimpressive results…5
  6. 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. 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. 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. 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. 10. Infant Mortality - 32% reductionUnder 5 Child Mortality – 35% reduction10165257129191111166050100150200250300Infant Mortality Rate Under 5 Mortality Rate200120062008
  11. 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. 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. 13. Results after 24 Months ofImplementation13
  14. 14. ANC: in RBF Facilities0153045607590NumbermonthANC1-4 Treatment14
  15. 15. ANC0153045607590NumbermonthANC1-4 Treatment ANC1-4 Control15
  16. 16. PNC: in RBF Facilities0153045607590NumbermonthPNC1-2 Treatment16
  17. 17. PNC0153045607590NumbermonthPNC1-2 Treatment PNC1-2 Control17
  18. 18. SBA: in RBF Facilities02468101214161820NumbermonthSBA Treatment18
  19. 19. SBA02468101214161820NumbermonthSBA Treatment SBA Control19
  20. 20. 0102030405060NumbermothDPT3 TreatmentDPT3: in RBF Facilities20
  21. 21. 0102030405060NumbermothDPT3 Treatment DPT3 ControlDPT321
  22. 22. RBF Indicators: Changes Between2010 Q3 and 2012 Q121.816.55.41.34.362.6-0.1-50510152025ANC1-4*** PNC1-2*** SBA** DPT3TreatmentControl22
  23. 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. 24. The longer RBF is in place, the better(PNC 1-2)3.97.716.53.11.560246810121416183months** 12 Months*** 19 months***TreatmentControl24
  25. 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. 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. 27. Improved Quality0.020.040.060.080.0100.0120.01 2 3 4 5 6 7 8 9 10 11 12 13ScoreHospitalsHospital Infection preventionBeforeAfter27

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