Results – Based Financing (RBF) in Health

Presentation by Gaston Sorgho,

HD Sector Leader – Central Africa

World Bank

AFRICA - HNPAFRICA - HNP

Inputs OutputsActivities

Traditional Financing

Results Based Financing

World Bank - AFR Health Nutrition Population

Paying for results: Taking quality into account

Paying for results: Taking quality into account

• Measuring the quantity of services produced by the health facility;

• Quarterly measurement of the quality of services the facility delivers;

Quantity * Unit price per service * Quality Index = Payment

• Adjustment made for remoteness or other difficulty. World Bank - AFR Health

Nutrition Population

Service NumberProvided

Unitprice

TotalEarned

Child fully vaccinated 100 $5 $500Skilled birth attendance 20 $10 $200Curative care <5 years 1,000 $0.5 $500TOTAL $1,200Remoteness Bonus +50% $1,800Quality Correction 60% $1,080

Example of Results Based Financing (RBF) in a Health Facility

Example of Results Based Financing (RBF) in a Health Facility

World Bank - AFR Health Nutrition Population

World Bank - AFR Health Nutrition Population

Service NumberProvided

Unitprice

TotalEarned

Child fully vaccinated 100 $5 $500Skilled birth attendance 20 $10 $200Curative care <5 years 1,000 $0.5 $500TOTAL $1,200Remoteness Bonus +50% $1,800Quality Correction 60% $1,080

Deciding on which services to include, i.e. , which are the priorities

World Bank - AFR Health Nutrition Population

Service NumberProvided

Unitprice

TotalEarned

Child fully vaccinated 100 $5 $500Skilled birth attendance 20 $10 $200Curative care <5 years 1,000 $0.5 $500TOTAL $1,200Remoteness Bonus +50% $1,800Quality Correction 60% $1,080

Setting the unit price for each service is complicated but prices can be adjusted

World Bank - AFR Health Nutrition Population

Service NumberProvided

Unitprice

TotalEarned

Child fully vaccinated 100 $5 $500Skilled birth attendance 20 $10 $200Curative care <5 years 1,000 $0.5 $500TOTAL $1,200Remoteness Bonus +50% $1,800Quality Correction 60% $1,080

Verifying that the claimed quantity of services were actually delivered requires care & a few approaches

World Bank - AFR Health Nutrition Population

Service NumberProvided

Unitprice

TotalEarned

Child fully vaccinated 100 $5 $500Skilled birth attendance 20 $10 $200Curative care <5 years 1,000 $0.5 $500TOTAL $1,200Remoteness Bonus +50% $1,800Quality Correction 60% $1,080

Measuring quality of care is an important challenge

Example of a Quantitative Checklist to determine Quality of Care Score

Date of Visit Mai Aout Nov Fev.

Availability of Drugs (0-10) 7 7 8 10Presence of staff (0-10) 5 6 8 9SNIS implementation (0-10) 3 3 5 5TB Case Detection Rate (0-10) 5 8 9 10Cleanliness of Health Center 6 7 8 10Quality of delivery care (0-10) 6 7 7 8Outreach activities (0-10) 2 5 6 8TOTAL SCORE (out of 70) 34 43 51 60TOTAL PERCENT 49 61 73 86

9

World Bank - AFR Health Nutrition Population

Service NumberProvided

Unitprice

TotalEarned

Child fully vaccinated 100 $5 $500Skilled birth attendance 20 $10 $200Curative care <5 years 1,000 $0.5 $500TOTAL $1,200Remoteness Bonus +50% $1,800Quality Correction 60% $1,080

Remoteness bonus reflects the fact that some facilities will face bigger challenges in attracting patients

Service NumberProvided

Unitprice

TotalEarned

Child fully vaccinated 100 $5 $500Skilled birth attendance 20 $10 $200Curative care <5 years 1,000 $0.5 $500TOTAL $1,200Remoteness Bonus +50% $1,800Quality Correction 60% $1,080

Example of Results Based Financing (RBF) in a Health Facility

Example of Results Based Financing (RBF) in a Health Facility

World Bank - AFR Health Nutrition Population

Example of what can the facility do with the $1,080

Example of what can the facility do with the $1,080

• Health facility operation costs(about 40%): - Maintenance and repair- Consumables- Drugs- Outreach - Other elements related to improving quality

• Performance bonus to health workers (about 60%) – criteria are defined

World Bank - AFR Health Nutrition Population