In addition, the Bank continues to support results-based financing operations in middle-income countries through the International Bank for Reconstruction and Development (IBRD).
The HRITF also provides knowledge and learning grants to 25 countries to gather and disseminate global learning about results-based financing. It is also building an evidence base for health through its support of rigorous, prospective impact evaluations on the causal effects, costs, and operational feasibility of results-based financing. Impact evaluations (currently underway in 28 countries) will contribute to local evidence-based policy decision-making, while cross-country meta-analysis will contribute to global knowledge.
In Afghanistan, the government reduced the death rate of children and infants from 257 and 165 to 97 and 77 per 1,000 live births, respectively, between 2002 and 2010. In the absence of effective government delivery of health services after the war, the government contracted out health services to non-governmental organizations (NGOs) in 2002. Performance-based contracting ensured that NGOs were free to decide how to use resources innovatively to reach intended results. Performance on quality of care of all contracted health facilities, as measured through a comprehensive balanced scorecard, increased by 32 percent from 2004 to 2007.
In Argentina, Plan Nacer, a social insurance program, aims to increase the health services use by pregnant women and children under age 5. Because of the program, nearly 1.5 million previously uninsured pregnant women and children now have basic health insurance and secure access to services. An early evaluation indicates that:
- The program increased the probability of a first prenatal care visit before week 13 of pregnancy by 8.5 percent, and before week 20 of pregnancy by 18 percent.
- The number of prenatal checkups rose by 17 percent.
- Improvements in services resulted in better child birth outcomes.
- Infant mortality began to decline and has fallen 20 percent since 2002, particularly in the poorest provinces.
In Burundi, the national-level performance-based financing program is improving maternal and child health through financial incentives to facilities to deliver more key services, with additional incentives for a quality scoring. Substantial improvements have been observed with most indicators covered by the national RBF program since it began in April 2010. These include the following changes: births at health facilities up by 25 percent, prenatal consultations up by 20.4 percent, children fully vaccinated up by 10.2 percent, curative care consultations for pregnant women up by 34.5 percent, and family planning obtained via health facilities up by 26.9 percent.
In Mexico, eligible poor families are benefiting from conditional cash transfers or vouchers, through the Oportunidades national program. After a decade, results in health include increased health visits (by 35 percent in rural areas and 26 percent in urban areas); decreased maternal and infant mortality (by 11 percent and 2 percent, respectively); increased growth by children under age 2; reduced anemia for children under age 2 (by 12.8 percentage points); higher levels of adequate nutritional intake of iron, zinc, and vitamins A and C (more than 90 percent of beneficiary children); and reduced sick days among rural children under age 5 (by 20 percent).
In Rwanda, incentives to health care providers for increasing the quantity and quality of health facility services led to a 21 percent increase in institutional deliveries, a 64 percent increase in preventive visits for children under age 2, and a 133 percent increase in visits for children ages 2-5. Use of antenatal services has continued to expand:
- The share of women attending fewer than two visits has shrunk from 18.6 percent in 2005 to 6.3 percent.
- More than one-third of pregnant women attended four or more antenatal care visits, including women in rural areas.
- Facility-based deliveries increased by 53 percent in the last three years and by 146 percent over 2005-2010, reaching 69 percent in 2010 and exceeding the target for 2011.
In Zimbabwe, the program’s goal is to increase coverage of maternal and neonatal health interventions in targeted districts by 2012. Initial results from operational data analysis show improvements in a number of performance indicators. The number of outpatient consultations in the two front- runner districts increased by roughly 3 percent from July 2011 to August 2012. During the same period, the number of women accessing modern family planning methods increased by 80 percent.