Health ResultsBased Financing HRBF

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Health Results-Based Financing (HRBF)

• Preliminary ideas and questions about monitoring
  HRBF

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Presentation Overview

• What is monitoring?
• Where to start?
• What to monitor?
• How to monitor?

3
Presentation Overview

• Management at country level
• Planning
• Support from global level
• Next steps

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What is monitoring?

• Source IHP Working Group, February, 2008

• Routine tracking and reporting of priority
  information about a program (i.e., inputs and
  activities) and its intended outputs and
  outcomesto assess whether resources are spent
  according to plan and whether the program is
  resulting in the expected outputs

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What is monitoring?

• Systematic, continuous process over time
• Descriptive
• Enhance implementation and interpretation
• Unintended or unforseen events and effects also
  important to capture
• What youve been doing in your projects!

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Where to start?
Logic model aka program theory
Rwanda
Afghanistan
Zambia
Eritrea
D.R. Congo
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Program Logic Model

• Explicit description/representation of how the
  program is organized and how its component parts
  will lead to the desired effects

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GENERIC LOGIC MODEL FOR HRBF
Service quality household capacity (outputs)
Coverage (outcomes)
MDGs 4 and 5 (impact)
Design and implementation processes
Govt. health services
Morbidity Reduction Mortality
Reduction Improved Nutrition

• High performing health workers and facilities, as
  well as financial, logistical, information and
  supply chain systems

Well-organized, financed and supported health
services

• Accessible, high quality, affordable, and
  efficient health services
• Household capacity (resources, skills, support,
  knowledge) to pursue health-promoting behaviors

Improved careseeking and utilization of
services Improved health-promoting behavior in
the household
PREVAILING LOGIC

• RBF project designed and vetted
• Policies, regulations modified or adopted, as
  necessary
• Performance agreements developed
• Payment modalities developed
• HMIS, community monitoring strengthened
• Performance validation methods and instruments
  developed

• Performance agreements executed
• Funds disbursed
• Data collected, analyzed, interpreted
• Independent technical financial audits
  completed

INCENTIVES ?
RBF Pilot
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WHAT TO MONITOR?2 PATHWAYS
Primary pathway
Health service quality household capacity
Intended processes and effects
Health services-RBF design
Coverage outcomes (Results)
Health services-RBF implementation
Secondary pathway
Unintended, unforeseen processes and effects

• Critical
• incidents
• Disruptive social or climatic events
• Significant
• administrative delays
• Changes in the political economy

• Process
• changes
• Accountability
• Management of finances, logistics, HR,
  information, facilities, supply chain
• Household decision-making

• Concurrent
• Events
• Similar incentive-
• based activities
• Other non-incentive
• based activities

• Unanticipated effects ( -)
• Coverage changes among non-rewarded indicators

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METHODS
Primary pathway
Health service quality household capacity
Intended processes and effects
Health services-RBF implementation
Health services-RBF design
Coverage outcomes (Results)
Options routine records of meetings and events,
financial reporting and audits, activity logs,
periodic progress reports, observation,
stakeholder interviews, group discussion, etc.
Options HMIS and community-based service
records reports Independent audit
Options Register/record review, clinical
vignettes, simulated client, direct observation
of care, exit interviews, household survey
Secondary pathway
Unintended, unforeseen processes and effects

• Unanticipated process
• changes

Critical incidents
Concurrent Events

• Unanticipated effects ( -)

Options participant observation, field diaries
and journals, key informant interviews, critical
incident logs, vignettes, testimonials, case
narratives, visual displays and representations,
activity matrices, observation, etc.
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MANAGEMENT
Primary pathway
Health service quality household capacity
Health services and RBF implementation
Intended processes and effects
Health services and RBF design
Coverage outcomes (Results)
1) MOH HMIS team 2) RBF MIS team/designate 3)
Independent auditors

• MOH MIS team? 2) RBF MIS team? 3) Third party?
• 4) Combination?

Secondary pathway
Unintended, unforeseen processes and effects
Critical incidents

• Unanticipated process
• changes

Concurrent Events

• Unanticipated effects ( -)

1) MOH MIS team? 2) RBF MIS team? 3) Third party?
4) Combination?
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PLANNING
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SUPPORT

• Budget cost-sharing between project and HDNHE
  central RBF funds other options?
• Technical assistance global monitoring support
  team based in HDNHE comparable to Impact
  Evaluation Team
• Monitoring network building a community of
  practice around monitoring and inter-country
  sharing of experience

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NEXT STEPS

• Country logic models (5)
• Estimate of what it will take (people, time and
  money) to monitor the two pathways (i.e., a
  costed plan)
• Put in place a monitoring team in each country to
  interact with the Global Monitoring Team and
  local impact evaluation team
• Provide TA, as requested, to country monitoring
  teams to enhance, extend existing monitoring
  processes

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Discussion

• Questions, Concerns, Suggestions

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Extra slideHealth Results-Based Financing

• 6-year grant (FY 2007-2013) from government of
  Norway
• Design, implement and sustain successful RBF
  pilots targeting health and nutrition of mothers
  and children (MDGs 4 and 5)
• Pilots are grants linked to IDA credits that will
  support the achievement of interventions with a
  proven impact on MCH