Results-based Aid: The Salud Mesoamérica 2015 (SM2015) Experience

Session: Using Results Based Financing to Scale-up Changes for Maternal and Neonatal Health: What Have We Learned?

Presenter: Ferdinando Regalia, Inter-American Development Bank
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Background: The Salud Mesoamérica 2015 Initiative (SM2015) is an innovative public-private partnership between the Bill & Melinda Gates Foundation (BMGF), the Carlos Slim Health Institute (ICSS), the Government of Spain, the Inter-American Development Bank (IDB) and the governments of the Central American countries and the State of Chiapas in Mexico. SM2015 works to reduce health equity gaps faced by extreme poverty populations of the Mesoamerican countries according to priorities established by the governments of the region.

Methodology: The SM2015 results-based financing (RBF) model uses money and independent measurement to change health-system incentives. The RBF model generates a new set of incentives to solve problems and achieve results, as a portion of grants are tied to independently verified results using external surveys conducted by the Institute of Health Metrics and Evaluation (IHME). Publication of results generates reputational incentives that can change current practices, while the financial incentive can be used by program managers for budget support in their programs.

Results: SM2015 donors provided US$114 million, leveraging nearly US$41 million in counter-part resources from country governments, for a total of US$155 million for the poorest populations in Mesoamerica. Countries who reach their goals receive 50 percent of their counterpart investment to use freely within the health sector. Demand-based technical assistance is also offered to countries. At the end of the first operation, which focused on system readiness, 4 of the 7 countries have met their externally verified goals, but all countries showed vast improvements in the permanent availability of critical inputs. Over 10 national policies were adopted or updated in the eight countries.

Conclusions: The model has demonstrated its effectiveness in improving process indictors; however, moving to the next phase of quality and coverage indicators will be more challenging. Lessons learned have been incorporated into SM2015, as well as traditional IDB programs.