Jamra primary scholl for children affected by HIV/AIDS, drugs or poverty, Senegal (c) Nell Freeman/Alliance Participants in the Photovioce project, Ecuador © Marcela Nievas for the Alliance
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Results-based financing for health: kill or cure?


Aids Alliance

On the occasion of World Health Day (7 April), health donors, including the GAVI Alliance and the Global Fund, policymakers, advocates and academics are meeting at the University College London today to discuss how to improve aid for health in developing countries.

The event - organised by Action for Global Health UK (AfGH) in partnership with The London School of Hygiene & Tropical Medicine and University College London Institute of Global Health is exploring the potential of using results based financing to improve health outcomes in some of the world’s poorest countries.

“Ensuring that the money we spend on health in some of the poorest countries in the world is used to the maximum benefit of people is critically important, but a focus on results can’t come at the cost of only reaching those easiest to reach and only supporting interventions that are easy to count,” said Sam McPherson from the International HIV/AIDS Alliance, a member of Action for Global Health.

“Donors are under more pressure to account for foreign aid spending, securing "value for money" is now at the top of the agenda,” added McPherson.

Traditionally donors have paid for inputs such as equipment and medicine and hoped that better health would follow. But health needs persist, especially those that require effective health systems to improve health outcomes. In Sub Saharan Africa for example the region continues to have the highest rate of maternal deaths in the world (average: 900 deaths per 100,000 live births).

Results-based financing has become an umbrella term for a range of mechanisms but they all aim to move from paying for inputs to paying for outputs and outcomes.  Performance-based aid is provided by multilateral agencies such as the Global Fund, GAVI Alliance and World Bank.

Speakers at the event include Mead Over, Center for Global Development; Wanjiku Kamau, Consultant for Norwegian Government on Pay 4 Performance (Tanzania); Kirsi Viisainen, Global Fund to Fight AIDS, TB & Malaria; Dr. Peter Hansen, GAVI Alliance; Kara Hanson, London School of Hygiene & Tropical Medicine; James Droop, UK Department for International Development

A new report Results-based financing: Making sure the UK’s aid for health delivers more health for the money  will be launched. It sets out the evidence that exists around the potentials and pitfalls of using results based financing to improve health in developing countries.

Haiti is one example of a country where results-based financing was introduced and made a difference. Health providers received incentives for increasing the proportion of children that were fully immunised and the proportion of pregnant women receiving antenatal care. Over seven years the programme increased immunisation coverage by 13 percent and number of assisted deliveries by 19 percent.

The report  shows that there some key principles to be considered that may help ensure that results-based financing has a positive impact on progress towards the health Millennium Development Goals in an equitable way. It cautions against thinking that it’s a silver bullet in all circumstances.

“Results-based financing is no panacea, but there are ways to ensure that it helps to provide more health for the money” says Caroline Halmshaw from Action for Global Health member Interact Worldwide.

“It’s important to consider context, recognising that results-based financing might not be appropriate in countries without the capacity to gather reliable statistics and health information for example, and to design programmes carefully to avoid perverse incentives,” added Halmshaw.

The UK Government is a leading voice in discussions about effective financing for development.  Action for Global Health research shows that slightly more than 15 per cent of the UK’s aid went to health in 2009 and this percentage is expected to increase.

The UK has now overtaken Spain as the largest contributor of real official development assistance in relation to GNI among five of the largest European economies (UK, France, Germany, Spain and Italy).

Aid has done much good. More than 4 million people have access to life-saving ARVs for HIV; the percentage of children protected from malaria by insecticide treated nets increased eightfold in 18 African countries between 2001 and 2005; 2.3 million people were cured of TB in 2008 and the number of infant deaths has declined steadily since 1990.

To find out more about health and aid effectiveness and understand how results based financing in health is linked to aid effectiveness, read Aid effectiveness for health from Action for Global Health 2011 report launched today.