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Success beyond numbers: The Salud Mesoamerica Ini6a6ve's (SMI) resultsbased aid approach to improve health services for the poorest in Mesoamerica InterAmerican Development Bank Social Protec6on and Health Division Dr. Ferdinando Regalia, Division Chief [email protected]
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Success beyond numbers: The Salud Mesoamerica Ini6a6ve's (SMI) results-‐based aid approach to improve health services for the poorest in Mesoamerica Inter-‐American Development Bank Social Protec6on and Health Division Dr. Ferdinando Regalia, Division Chief [email protected]
What does SMI aim to change? SMI Areas: Baseline Situa6on (2012) – Stun6ng
Guatemala: 62.1%
Panama: 55.9%
Chiapas: 41.8%
What does SMI aim to change? SMI Areas: Baseline Situa6on (2012) – Modern Contracep6ve Prevalence Rate
El Salvador: 53.5%
Chiapas: 47.3%
Guatemala: 25%
Panama: 9.7%
What is SMI? Objec6ve: Reduce inequi;es in maternal, neonatal, and child health
SMI: Innova;ve Public-‐Private Partnership • Bill & Melinda Gates Founda;on
• Carlos Slim Founda;on
• Government of Spain
• 8 Mesoamerican Countries
• IDB
Grants: US$ 114m
Domes6c Funding: US$ 55m
SMI approach: cri;cal features
Target the poorest 20% of the popula;on
Results Based Aid (RBA) model
SMI approach: cri;cal features
Evidenced based interven;ons and systemic approach
Innova;ve demand-‐side interven;ons
Context specific and ac;on-‐oriented technical assistance
Independent measurement of performance Regional dimension and benchmarking
SMI Scoring system ‘All or nothing’ rule focuses efforts on all targets, but makes receiving the performance award more challenging
Receive Performance Tranche
Overall score of 0.8 or above
is required
All indicators have equal weights
If indicator meets target scores 1/total
9-‐12 indicators per opera;on
Miss 1-‐2 indicators at
most
What do countries commit to?
Key Performance Indicator Baseline 1st Opera6on Targets
2nd & 3rd Opera6on Targets
Primary Health Centers with permanent availability of medicines and inputs for obstetric and neonatal emergencies
62.5% 80%
Primary Health Centers with permanent availability of medicines and inputs for the treatment of diarrhea and pneumonia in children under 5
0% 80%
Ins;tu;onal births by skilled personnel 63.9% +12 PP
Management of obstetric complica;ons 11% + 40 PP Children less than 5 years that received oral rehydra;on salts and zinc during the last episode of diarrhea
0% +25 PP
Anemia in children 6-‐23 months 35.3% -‐ 15 PP
Example: Honduras (select targets)
SMI Independent Performance Measurement
Final Evalua6on
Baseline Surveys*
Follow-‐up Surveys*
Follow-‐up Surveys*
1st Opera6on (18-‐24 months)
2nd Opera6on (18-‐24 months)
3rd Opera6on (18-‐24 months)
First verifica6on of targets
Follow-‐up Surveys*
Second verifica6on of
targets
Third verifica6on of
targets
*Health Facili;es and Popula;on Based Surveys
We are here. In most countries, the second opera6on is in progress.
What makes SMI different?
From… To… • Beneficiaries and Donors • Financing inputs: Buying
micronutrients • Thinking about who and
what to support • Risk intolerance and
resistance to change • Assuming we made a
difference
• Partners and joint-‐investors • Buying Results: Reducing
Anemia • Focusing on leverage points
and removing boflenecks to reach targets
• Taking smart risks, learn from failures and adapt
• Verifying we met our goal
SMI first round of results (18-‐24 months)
§ Very sizeable changes in the supply of essen;al health care in a short period in all countries
§ 69% of the 83 nego6ated targets met in 8 countries
§ El Salvador, Honduras, Nicaragua, Panama and Costa Rica received the performance tranche (PT)
§ Belize, Chiapas and Guatemala mastered an impressive progress but fell short of the cut off to receive the PT
§ Chiapas, Guatemala implemented an improvement plan, with their own resources, were re-‐measured and achieved all the targets
Panama: success stories
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
100.0%
7010¹ 7020 7040² 7050 7192³ 7710 7730⁴ 7740⁴
Baseline
18 months
Child care
Antenatal and postpartum care
Delivery and newborn care
Family planning
Availability of staff
AIN-C registries for children under 24 months
Communities with water and sanitation plans
Birthing plans approved by communities
perc
ent
Chiapas: success stories
0
10
20
30
40
50
60
70
80
90
100
Baseline
18-‐Month
PIPM
Child care Antenatal and postpartum care
Emergency obstetric and neonatal care
Delivery and newborn care
Family Planning
*All percentages reflect the Performance Improvement Plan Measurement (PIPM) definitions with no stock-out
perc
ent
Taking stock of SMI: voices from the countries*
*In depth interviews with a sample of na;onal and district level leaders of the Ministries of Health (independent evalua;on by Rena Eichler and Susan Gigli).
Posi6ve Aspects • Overall feedback is highly posi6ve
• Management by results is new and perceived as cataly;c and creates new partnerships
• SMI is enhancing Know-‐How
• New evidence based strategies and results oriented interven6ons are being introduced.
• Supply systems are being strengthened
Challenging Aspects
• Short Timelines
• Some targets were too ambi;ous
• Construc;on of some indicators could be improved
• Ini;al incomplete understanding of what needed to happen to achieve targets
• Frustra;on with the country’s own systems and their capacity to move quickly
Thank you
www.saludmesoamerica.org
