Data Driving Changes: SM2015 Experience Using Innovative Tools to Reduce the Equity Gap

Session: Using Data to Improve Health System Capacity to Respond to Maternal and Neonatal Health Challenges

Presenter: Ali Mokdad, Institute for Health Metrics and Evaluation, Department of Global Health at the University of Washington
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Background: A large-scale, cross-country, results-based financing initiative, Salud Mesoamerica 2015 (SM2015), was launched to reduce disparities in maternal, neonatal, and child health. SM2015’s unique design includes data collection and measurement of key performance indicators at multiple stages of implementation. This presentation discusses the initiative’s results and analysis, providing an indication of the progress engendered thus far and implications for future policy and program design.

Methods: Health indicators and targets were set with governments considering in-country norms and priorities, assessment of national and sub-national metrics, expert advice, and a cost-benefit model. SM2015 was designed to support 2-3 operations per country, each involving a performance assessment of process, coverage, and quality-of-care indicators. Intervention and control areas were designated to evaluate impact. To establish a baseline, 90,000 censuses, 20,225 household interviews, and 479 health facilities surveys were conducted. The first follow-up measurement, 18-24 months later, included surveys of 379 intervention health facilities. One-tailed z-tests of proportions and other statistical tests assessed the probability of reaching targets and presence of significant increases and decreases.

Results: SM2015 findings emphasize the disparities in maternal and neonatal health across Mesoamerica. Skilled antenatal care, institutional delivery, skilled birth attendance, and postnatal care coverage were estimated to be lower among poorest populations than national averages. Follow-up results indicated that El Salvador, Honduras, Nicaragua, and Panama met performance targets while Mexico, Guatemala, and Belize did not. However, significant increases were observed in all countries in components of supply-side health indicators.

Conclusion: The SM2015 evaluation has been an important input to progress in maternal and neonatal health in Mesoamerica, as it provides comparable supply- and demand-side evidence of how health and health services are evolving in the region. Initial improvements observed at the facility-level hold insights about the potential to scale similar results-based financing initiatives in other areas.