Perspectives on Demand Side Financing, Social Safety Nets and the MDGs LEAD Workshop on Demand Side Financing, Social Safety Nets and MDGs 9th July 2013 Perspectives on Demand Side Financing, Social Safety Nets and the MDGs Dr. Adnan A. Khan Director Research and Development Solutions, Islamabad

Outline of DSF Demand side financing changes health behaviors +/- provides health financing May help the poor May promote health and progress towards MDGs Limited application unless services are available Experience thus far mainly with covering services/ commodities – not for transport, opportunity costs Sustainability How long does it take to change behaviors?

Challenges Dependency of recipients and misuse Targeting the poor Administrative costs/Quality control Systematic corruption Lack of suppliers Sustainability of demand side financing schemes

Suggestions CCT or Vouchers for Family Planning (particularly long term methods) CCT or Vouchers for Safe birthing – private facilities CCT for Immunization

Lessons Learnt Can increase the demand for RH services in a community Help include underprivileged and promote better RH Help overcome limitations in access and uptake of RH services – esp in rural locations where there aren't providers Most local experiences with family planning and reproductive health – mostly in the private sector Can allow cost savings over the public sector – with reduced cost of healthcare and reduced necessity of permanent government employees Duration long enough to bring about behavioral change Should have rigorous monitoring mechanisms that include both management and financial oversights Limited value in absence of economic uplift Often the services promoted by DSF or other schemes disappear once the intervention concludes. Either the interventions should be long enough to induce behavior change or other means of sustaining funding should be considered.

Recommendations Should target usage and access to RH and FP services in remote locations and for marginalized populations, Stringent monitoring and oversight mechanisms (which in turn can be contracted out) Specific schemes that may be addressed with DSF can be: Skilled birth attendance or facility deliveries Ante- and postnatal care, family planning services Nutrition (including micronutrients) of mothers and children Family planning, post partum or post abortion care Specially suited for locations where the public sector is perennially short staffed

Recommendations If successful, should become part of routine (non dev) budget Types of support can include Payments of services to be availed Monetary incentives to actually avail services Costs of transport Following considerations are paramount Will the government pay for doctors only, or to paramedics, LHVs etc, homeopaths, hakims, or will it extend the network to include non-formal providers. How will quality be maintained What will be the payment modality (monthly or quarterly re-imbursement, who pays the patient/ client) What will be the accountability mechanisms

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