Not your cookie-cutter results-based aid initiative: Salud Mesoamerica Initiative’s experience improving health for the poorest in Mesoamerica 

Abstract

work is licensed under a Creative Commons IGO 3.0 AttributionNonCommercial-NoDerivatives (CC-IGO BY-NC-ND 3.0 IGO) license (http://creativecommons.org/licenses/by-nc-nd/3.0/igo/ legalcode) and may be reproduced with attribution to the IDB and for any non-commercial purpose. No derivative work is allowed.Any dispute related to the use of the works of the IDB that cannot be settled amicably shall be submitted to arbitration pursuant to the UNCITRAL rules. The use of the IDB's name for any purpose other than for attribution, and the use of IDB's logo shall be subject to a separate written license agreement between the IDB and the user and is not authorized as part of this CC-IGO license.Note that link provided above includes additional terms and conditions of the license.The opinions expressed in this publication are those of the authors and do not necessarily reflect the views of the Inter-American Development Bank, its Board of Directors, or the countries they represent. AbstractSalud Mesoamerica Initiative (SMI) is a unique results-based aid initiative that rewards countries for achieving health targets in the poorest municipalities in Mesoamerica. A partnership between private and public donors and governments, it offers lessons for philanthropists, corporate social responsibility teams, and bilateral donors about how to alter development assistance from the usual model of paying for inputs to a new one in which countries are paid for achieving results for their poorest populations. What makes this model of RBA feasible is its reliance on the staff, relationships, systems, and implementation capability of the Inter-American Development Bank and the dedicated unit that supports countries. Countries commit to achieve targets that progress from system readiness metrics to outcomes. Verification is based on externally conducted household and facility surveys. Five out of the eight countries achieved first-phase targets and received a performance payment, and all countries improved on key health system metrics.

Access and use of oxytocin for postpartum haemorrhage prevention: a pre-post study targeting the poorest in six Mesoamerican countries

“…This analysis attests that clinical standards of care could be achieved in Mesoamerica with proper monitoring and management of oxytocin supplies. As expected from the implementation timeline, the first stage of the SMI focused on improving system readiness, namely strengthening facility infrastructure, supply chains, procurement processes, storage practices and inventory monitoring of drugs and equipment 14 16. Consequently, increasing the availability of oxytocin, the primary goal of the first phase of the initiative, was achieved.…”

“…SMI is a public–private partnership between the Ministries of Health in participating Mesoamerican countries and donors that focuses on improving four major domains of maternal and child health: preventive child health and vaccines; family planning; antenatal care and postpartum care; and essential obstetric and newborn care (EONC) 15. SMI follows a results-based financing model16 17 in which Ministries of Health commit to achieve negotiated targets for 8–12 performance indicators. Within the EONC domain, health facility performance indicators focused on the availability of equipment (ie, resuscitation equipment, caesarean section kits, stethoscopes), essential medications (ie, antibiotics, antihypertensives) and laboratory inputs (ie, glucometer, cell counter).…”

Is Results-Based Aid More Effective than Conventional Aid?: Evidence from the Health Sector in El Salvador

“…Second, by definition, RBA models bundle financial incentives with funding to achieve a common objective, making it difficult to isolate the differential effects of the aid component from the results-based conditions (Janus 2014 Our analysis of investments in infrastructure and personnel suggests that the increase in services was driven at least in part by an accelerated investment in health units and staffing of physicians. Anecdotal evidence suggests that this may have been accomplished through a more focused implementation of the community health model in RBA municipalities by national health authorities, motivated by the urgency of gaining the incentive tranche which could then be invested in further expansion of the health reform model, as well as potential reputational effects of meeting the RBA targets ("Misleading means", 2014;Regalia et al, 2017). SMI used a similar RBA scheme for several countries in the region, and countries could compare their performance with others.…”

“…Available qualitative evidence suggests that the more rapid expansion of services was motivated by the RBA performance incentives, which national officials viewed as a flexible funding source for additional investments in the health reform nation-wide. Health authorities may have also been motivated by the reputational repercussions of participating in a regional initiative (Regalia et al 2017). …”

Is Results-Based Aid More Effective than Conventional Aid?: Evidence from the Health Sector in El Salvador

“…Our analysis of investments in infrastructure and personnel suggests that the increase in services was driven at least in part by an accelerated investment in health units and staffing of physicians. Anecdotal evidence suggests that this may have been accomplished through a more focused implementation of the community health model in RBA municipalities by national health authorities, motivated by the urgency of gaining the incentive tranche which could then be invested in further expansion of the health reform model, as well as potential reputational effects of meeting the RBA targets ("Misleading means", 2014; Regalia et al, 2017). SMI used a similar RBA scheme for several countries in the region, and countries could compare their performance with others.…”