Discussion » Results-based financing (RBF) Models Are Encouraged by Salud Mesoamerica 2015 (SM2015)
Results-based financing (RBF) Models Are Encouraged by Salud Mesoamerica 2015 (SM2015)
Results-based financing (RBF) has shown promising results increasing healthcare coverage and quality for the poorest populations. Salud Mesoamerica 2015 (SM2015) is an example an encouraging new model to address inequalities in a more effective and efficient way. SM2015 aims to reduce maternal and child health inequalities through a result-based financing model. (SM2015) is a public-private partnership between the Bill & Melinda Gates Foundation, the Carlos Slim Foundation, the Government of Spain, the Inter-American Development Bank (IDB) and the countries of Central American and the state of Chiapas in Mexico.
At the start of the program, the IDB and the country agree to set of process, coverage, quality and impact targets that are externally verified by a third partner. To design a program to meet the targets, each country receives a donation that is matched by country funds to implement evidence-based interventions in the poorest areas. If the country meets the previously agreed targets, it receives an incentive; half of the country funds initially invested for reimbursed for unrestricted use within the health sector. Even when donations are less than 1% of the health budget, systemic changes have already been achieved.
Unlike other RBF programs, results expected by SM2015 include changes to national policies, coverage of healthcare interventions and quality of care. With this purpose, independent household and health facility surveys are collected in every country. The IDB partnered with the Institute for Health Metrics and Evaluation (IHME) at the University of Washington to conduct the surveys. In addition to assessing performance, surveys provide robust and comparable data about the maternal and child health of the poorest populations.
Baseline surveys revealed important health inequalities. Even when most countries have achieved high coverage at the national level of key interventions to reduce maternal and child mortality, important gaps remain for the poor. For instance, the contraceptive prevalence rate in the poorest areas in Mesoamerica is more than 20 percentage points under the national average. Institutional birth by qualified staff is particularly low in areas with high indigenous populations, such as the poorest areas of Chiapas and Guatemala, where around 1 in 4 women has access to institutional deliveries by qualified staff.
After 24 months of program implementation, all countries have achieved important results, increasing the availability of equipment and supplies in medical units and updating national norms. For instance, in Nicaragua, the percentage of Health Facilities with continuous availability of inputs for emergency obstetric and neonatal care increased from 60 to 90.9%. In El Salvador, the Community Health Teams with inputs and equipment for child care increased from 36.2 to 92.2%. In Chiapas, Mexico inputs and equipment for prenatal and postnatal care increased from 3.6 to 45.8%. Panama increased the number of basic attention units with availability of family planning methods from 7.1 to 78.9% and Belize from 73.7 to 89.5% El Salvador, Guatemala, Honduras and Panama have updated national norms for micronutrient supplementation in children 6 to 23 months; an initial step towards decreasing anemia. In Panama and El Salvador zinc has been included in standards for management of diarrhea in children.
In Costa Rica, SM2015 has encouraged cross-sector collaboration addressing teenage pregnancy. The Ministry of Health, the Ministry of Education and the Department of Social Insurance are working together to develop integrated strategies to prevent teenage pregnancies and support young mothers.
SM2015 has helped Ministries of Health leverage funds for the poor and the health sector. In El Salvador, for example, a specific target was set to increase spending for the poor. In all countries, even when targets are in health, SM2015 given the argument for the Ministry of Finance to ensure the funds needed were available (including counterpart funding as well as resources to meet targets).
In the next two years, Ministries of Health throughout the region will have to achieve even more challenging and ambitious targets. Countries have committed to achieving healthcare coverage and quality targets.
The RBF model implemented by SM2015 could be expanded to a wider set of social development goals. Giving realistic, ambitious and measurable targets for outcome and impact level indicators to sectors that earlier worked independently could open paths for improved solutions.
Discussion » Results-based financing (RBF) Models Are Encouraged by Salud Mesoamerica 2015 (SM2015)
Results-based financing (RBF) Models Are Encouraged by Salud Mesoamerica 2015 (SM2015)
Results-based financing (RBF) has shown promising results increasing healthcare coverage and quality for the poorest populations. Salud Mesoamerica 2015 (SM2015) is an example an encouraging new model to address inequalities in a more effective and efficient way. SM2015 aims to reduce maternal and child health inequalities through a result-based financing model. (SM2015) is a public-private partnership between the Bill & Melinda Gates Foundation, the Carlos Slim Foundation, the Government of Spain, the Inter-American Development Bank (IDB) and the countries of Central American and the state of Chiapas in Mexico.
At the start of the program, the IDB and the country agree to set of process, coverage, quality and impact targets that are externally verified by a third partner. To design a program to meet the targets, each country receives a donation that is matched by country funds to implement evidence-based interventions in the poorest areas. If the country meets the previously agreed targets, it receives an incentive; half of the country funds initially invested for reimbursed for unrestricted use within the health sector. Even when donations are less than 1% of the health budget, systemic changes have already been achieved.
Unlike other RBF programs, results expected by SM2015 include changes to national policies, coverage of healthcare interventions and quality of care. With this purpose, independent household and health facility surveys are collected in every country. The IDB partnered with the Institute for Health Metrics and Evaluation (IHME) at the University of Washington to conduct the surveys. In addition to assessing performance, surveys provide robust and comparable data about the maternal and child health of the poorest populations.
Baseline surveys revealed important health inequalities. Even when most countries have achieved high coverage at the national level of key interventions to reduce maternal and child mortality, important gaps remain for the poor. For instance, the contraceptive prevalence rate in the poorest areas in Mesoamerica is more than 20 percentage points under the national average. Institutional birth by qualified staff is particularly low in areas with high indigenous populations, such as the poorest areas of Chiapas and Guatemala, where around 1 in 4 women has access to institutional deliveries by qualified staff.
After 24 months of program implementation, all countries have achieved important results, increasing the availability of equipment and supplies in medical units and updating national norms. For instance, in Nicaragua, the percentage of Health Facilities with continuous availability of inputs for emergency obstetric and neonatal care increased from 60 to 90.9%. In El Salvador, the Community Health Teams with inputs and equipment for child care increased from 36.2 to 92.2%. In Chiapas, Mexico inputs and equipment for prenatal and postnatal care increased from 3.6 to 45.8%. Panama increased the number of basic attention units with availability of family planning methods from 7.1 to 78.9% and Belize from 73.7 to 89.5% El Salvador, Guatemala, Honduras and Panama have updated national norms for micronutrient supplementation in children 6 to 23 months; an initial step towards decreasing anemia. In Panama and El Salvador zinc has been included in standards for management of diarrhea in children.
In Costa Rica, SM2015 has encouraged cross-sector collaboration addressing teenage pregnancy. The Ministry of Health, the Ministry of Education and the Department of Social Insurance are working together to develop integrated strategies to prevent teenage pregnancies and support young mothers.
SM2015 has helped Ministries of Health leverage funds for the poor and the health sector. In El Salvador, for example, a specific target was set to increase spending for the poor. In all countries, even when targets are in health, SM2015 given the argument for the Ministry of Finance to ensure the funds needed were available (including counterpart funding as well as resources to meet targets).
In the next two years, Ministries of Health throughout the region will have to achieve even more challenging and ambitious targets. Countries have committed to achieving healthcare coverage and quality targets.
The RBF model implemented by SM2015 could be expanded to a wider set of social development goals. Giving realistic, ambitious and measurable targets for outcome and impact level indicators to sectors that earlier worked independently could open paths for improved solutions.