Clinton Global Initiative: MSH Fulfills $12.5 Million Commitment to Expand Performance-Based Financing Incentives
CLINTON GLOBAL INITIATIVE: September 20-23, 2010
(New York, NY) Management Sciences for Health (MSH) today reported that, after two years and with the support of USAID, it has exceeded its four-year $12.5 million CGI Commitment to Action to introduce and expand Performance-Based Financing (PBF), resulting in dramatically improved quality and delivery of health services for millions of people in Rwanda and Haiti. PBF empowers health managers to allocate resources in a way that rewards meeting health goals. By improving financial management capacity and expertise, PBF strengthens the sustainability and performances of ministries of health, district, and community institutions, and NGOs. A video about MSH's Performance-based Financing Commitment will be featured at the CGI during two of the Market-Based Solutions Breakout sessions: Supply Chains of Opportunity & Democratizing Education on Wednesday, September 22, from 10:30-11:30 a.m.
In Haiti, MSH expanded PBF into the public sector and enhanced community-based services to improve access to health services. Before the 2010 earthquake, nearly 4,000,000 people (43%) of the population were reached in all 10 geographic departments in a program managed by MSH's SDSH project (Santé Pour le Développement et la Stabilité d'Haïti). More than $50 million was secured in leveraged contributions from over two dozen organizations from October 2009 to April 2010 (including the months after the earthquake). This new initiative is scaling up by establishing a functioning planning group of private sector partners in partnership with civil society to attract and channel financial and professional resources in order to benefit the people of Haiti. It is a promising model for establishing a sustainable resource flow that is fully owned and guided by the people of Haiti. As the community PBF initiative is established, these resources can eventually flow directly to network NGOs and/or local health task forces.
"Performance-based financing is a powerful means of expanding access to high quality, efficient health care services by providing incentives to providers and facilities for improved results," said Jonathan D. Quick, MD, MPH, President and CEO of MSH.
"In pursuit of the Millennium Development Goals and the fundamental human right to universal access to quality health care, PBF can increase use and quality of health care services, stabilize or decrease costs, help use limited resources effectively, and improve staff motivation, and morale—a proven incentive for retention of health workers," said Dr. Quick.
In Rwanda, the PBF program contributed to: doubling deliveries in health centers (from approximately 23% in 2006 to 42% in 2008), reducing neonatal and maternal mortality; doubling the monitoring of child growth and nutritional status, and doubling vaccinations for pregnant women to protect them from tetanus. The MSH PBF program also accelerated an increase in Rwandan health center quality scores by 20 points on a scale of 100, including increases in quality of general management, health center cleanliness, and the overall quality of outpatient, obstetric, family planning, vaccination, nutrition, and HIV/TB clinics.
This year, community-based PBF was established in Rwanda. Over 1,000 trainers are in the process of being trained to use two cell-phone based technologies to be followed by health center-led trainings of 45,000 community health workers. 45,000 phones and solar chargers have been purchased. The community health worker program is one of the Rwandan Ministry of Health's major initiatives to expand access to care to meet the country's Millennium Development Goals to reduce maternal and infant mortality. Four health workers are based in each of the approximately 15,000 villages delivering a basic package of health care services, including: integrated management of childhood diseases (malaria, diarrhea, respiratory infections), promoting facility-based deliveries, antenatal care, family planning, and testing for HIV/AIDS and helping with disease surveillance. The health workers will use cell phones to enter health reports. Selected data from the system will be transferred to the Community Performance-based Financing Web application which calculates quarterly PBF payments deposited in CHW cooperative accounts.
Another system RapidSMS will track vital events related for all pregnant women and infants through the age of 1 year. Women are registered by the community health workers at the first sign of pregnancy, tracked through delivery and ante-natal visits. Risks are reported and referred. Immunizations are also reported for both mother and child.
MSH's partners in the CGI Commitment to Action are:
In Haiti: The Government of Haiti's Ministry of Public Health and Population, the US Agency for International Development, private voluntary organizations, and private commercial sector.
In Rwanda: The Government of Rwanda's Ministry of Public Health; the Belgian Technical Cooperation; and US Agency for International Development.
For more than a decade, MSH has designed, implemented, and supported innovative PBF for health programs. Successes include dramatic and sustained improvements in immunization rates and reduced infant mortality. MSH has supported PBF initiatives in 14 countries.