Click To Edit Master Title Style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,*,*,Stocktaking of Results-Based Financing(RBF)Experiences in the World Bank,Logan Brenzel,HDNHE,July 8,2021,1,Questions to be Addressed by the Stocktaking Review,What policy or health system issues were RBF mechanisms trying to address in countries?,What is the scale,scope and types of RBF mechanisms that have been supported by the World Bank across regions?,Who are the beneficiaries of RBF mechanisms and to what extent are the needs of the poor being addressed?,What type of lending instruments has been used and what is the level of World Bank lending for RBF?,What were some of the design features of the RBF mechanisms?,What has been the experience with monitoring and evaluating RBF mechanisms?,What results have been achieved in these projects?,What have been the challenges in the design and implementation of RBF mechanisms?,What are the lessons learned from the review of projects,and what are the prospects for sustainability?,What are some recommendations for the way forward for the World Bank on RBF?,2,Methods,Review of the portfolio(Board approval FY1995-2021),Health sector performance as the primary theme(code 67),Review of 260 active and closed projects,Project portal source of information,Desk review of PIDs,PADs,ICRs,other documents,Some follow-up with TTLs,Quick review to triage the total sample,More detailed review of projects and data entry into spreadsheets for comparison using Table 1 to categorize RBF activities,Limitations:,Project documents are intentions and review is limited to what is in those documents,ICRs reflect others opinions and estimates of results,Reviewed similar documents across projects but did not drill down into details of individual projects,Health Systems Performance theme will not capture all activities in this area(conservative estimates),3,Definition of RBF for Health Used in the Review,RBF for health is a cash payment or non-monetary transfer made to a national or sub-national government,manager,provider,payer,or consumer of health services after predefined results have been attained and verified.Payment is conditional on measureable actions being undertaken.,4,Categories of RBF Activities(Table 1),Recipients,RBF Mechanism,Behavior Change,National Government,Transfer of a portion of the loan or grant on the basis of verified achievement of health targets from a set of pre-specified indicators,National government puts in place the necessary policy framework and programmatic support to achieve results.,Ministry of Health Administrative Levels,(entities that manage,support,and supervise delivery of services at central,provincial,district levels,and/or their managers),Portion of budgets or performance bonuses received at sub-national administrative levels contingent on achievement of pre-agreed performance targets often codified within a contracted arrangement.Sub-national administrative levels often have performance agreements with health facilities.,Central,provincial,and/or district level managers have an incentive to support achieving results and to organize their planning,budgeting,supervision and monitoring systems accordingly,Health Insurance Entities,Payments made to health insurance entities conditional on their meeting pre-agreed targets for numbers of new enrollees per period.,Health insurance entity organizes itself to meet coverage targets,Health Facilities,(entities that deliver services,such as hospitals,health centers and clinics,group practices,public and private sector,including NGOs),Payments made to health facilities(fee-for-service or target-based payments)on the basis of providing an agreed-upon type,level,and quality of services.Payments are retained in the health facility to improve quality of services and performance.,Facility organizes itself to deliver services and/or meet performance targets and achieve results to receive payment or bonuses.,5,Categories of RBF Activities(contd),Recipients,RBF Mechanism,Behavior Change,Health Care Workers,(individuals,managers,or the team as a whole),Payments(performance bonuses or in-kind rewards)made to individual health workers,managers,or to teams of health workers on the basis of services provided or achieving/exceeding pre-agreed targets and results between the health facility and the health worker(s).,Health workers motivated to provide specified types and quality of services,and to be present at the facility,Community-level organizations,Payment provided to community-level organizations conditional on achievement of results spelled out in agreements between the community and the health facility or other administrative level in the government.,Community groups solve problems and organize themselves and community members to achieve results,Households,Financial payments made to households as a welfare transfer conditional on household members utilizing specific health and education services(