《theworldofinitiatives-rbfhomepagerbfhealth举措——世界的rbfrbf健康主页》由会员分享，可在线阅读，更多相关《theworldofinitiatives-rbfhomepagerbfhealth举措——世界的rbfrbf健康主页（22页珍藏版）》请在金锄头文库上搜索。
1、Stocktaking of Results-Based Financing (RBF) Experiences in the World Bank,Logan Brenzel, HDNHE July 8, 2009,2,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 mechani
2、sms 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 fe
3、atures 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
4、 what are the prospects for sustainability? What are some recommendations for the way forward for the World Bank on RBF?,3,Methods,Review of the portfolio (Board approval FY1995-2008) Health sector performance as the primary theme (code 67) Review of 260 active and closed projects Project portal sou
5、rce 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 intentio
6、ns 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 (conservati
7、ve estimates),4,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 condi
8、tional on measureable actions being undertaken.,5,Categories of RBF Activities (Table 1),6,Categories of RBF Activities (contd),7,Database,Basic project information project identification number, dates of World Bank Board approval, date of project effectiveness, lending amounts (IBRD, IDA, or grants
9、), proportion of the project allocated to health, task team leader, lending instrument) Rationale for pursuing an RBF strategy Beneficiaries and whether the project focused on poor or vulnerable groups Description of RBF mechanisms Whether the project focuses on monetary or non-monetary incentives S
10、cope of the RBF (entire project, component, pilot activities, studies) Development and project indicators Type of evaluation foreseen Financing and disbursement Implementing agency and project management Prospects for sustainability,8,Rationale and Objectives for RBF Approach,Improve efficiency, equ
11、ity, effectiveness or access to services Increase service delivery to the poor Address IMR/U5MR/MMR Address worsening health conditions Closed projects tended to focus on “systems” outputs/outcomes more Active projects tending to address health outputs/outcomes,9,RBF Experience of the World Bank,10,
12、RBF Activities by Region,11,Evolution of Bank Support for RBF Activities Over Time,12,Beneficiaries of RBF Activities,13,RBF Mechanisms Found in World Bank Projects,14,Types of Incentives Found in World Bank Projects with RBF Activities,15,Lending Instruments Used for RBF Activities,16,Funding for R
13、BF Activities,Impossible to know funding for RBF activities specifically with any degree of accuracy Total value of support (IBRD/IDA/grants) for entire projects with RBF Activities: $3.79 billion (FY95-08) $2.29 billion in active projects 1.5 billion in closed projects IDA loans represent 68% of su
14、pport in active projects and only 9% in closed projects Conclusion: more RBF activities being supported in lower income settings Possible area to track in the future,17,Projects with Substantial RBF Activities,Definition: whole project or significant component(s) devoted to RBF 24 Projects identifie
15、d as having substantial RBF Activities 17 active projects 7 closed projects LAC had 43% of these projects; AFR 27% 71 different types of RBF mechanisms supported (2.3 per project) Performance agreements with sub-national administrative levels Performance-based contracts with public facilities and NG
16、Os $2.4 billion in support (63% of total support for projects as a whole),18,Types of Evaluations Planned for Projects with RBF Activities,19,Lessons Learned from the ICR Review (n=12),Political commitment & country ownership particularly for decentralized levels Involvement of all stakeholders in design ( to mitigate resistance to reforms) Quality improvements important complement to quantity of care improvements Important to analyze current incentive structure before layering additiona
