Salud Mesoamérica Initiative Rena Eichler, PhD Broad Branch Associates

The Initiative is a five year public-private partnership between the Bill & Melinda Gates Foundation, the Carlos Slim Health Institute, the Government of Spain, the IDB and the governments of 8 countries in the Mesoamerican region Supports the efforts of the governments of the region to achieve the health Millennium Development Goals A portion of grant funding is conditional on achieving health results focused on the poorest. SM2015 INITIATIVE

Belize Costa Rica El Salvador Guatemala Honduras Nicaragua Panamá Chiapas, Mexico ELIGIBLE COUNTRIES

Total contribution: US$142million Bill & Melinda Gates Foundation Carlos Slim Health Institute Government of Spain- AECID All donors contributing equally to all scheduled activities SM2015 BUDGET

JUSTIFICATION

In the Mesoamerican region there are deep and large gaps between the health and welfare of the population of lower income and highest income quintiles. WHY MESOAMERICA? Lowest Highest Source : Tristao. I. Perfiles de los países Mesoamericanos. IDB Working paper 2010

The poorest 20% access fewer services of proven effectiveness and quality is inadequate. Reasons: Public spending is low and inequitable. Health policy is not necessarily guided by evidence. Limited accountability for results at all levels. Weak/dysfunctional incentive s to increase the coverage and quality of health services Social, financial and geographic access barriers In addition: Not enough regional cooperation in the control/elimination of malaria and dengue. MAIN PROBLEMS

OBJECTIVES AND STRATEGIES

1.Increase supply, quality and utilization of basic health services in the target population 2.Create a strong policy and financial commitment to close the equity gap in health 3.Contribute to awareness about the implementation of large-scale interventions of proven efficacy among the poorest SPECIFIC OBJECTIVES GOAL: Reduce maternal and infant mortality in women and children under 5 years of the 20% poorest

SM2015 IMPACT AND PROCESS THEORY Increased demand for interventions among poor Increased availability and use of evidence for shaping pro- poor policy and practice Increased allocation of health resources to the poorest populations Increased supply of quality services among poor Reduction in neonatal, child, and maternal mortality in target population Increase in effective coverage, at scale, of key interventions New incentives in aid relationship via PBA model

HOW DOES SM2015 WORK?

STRUCTURE Inter-American Development Bank General Administrator Coordination Unit based in Panama SM2015 dedicated coordination unit staffed by the IDB Governments Implementing and co-financing partner

RESULT BASED FINANCING Agreement between the IDB and the governments Results-based disbursement Using predetermined performance indicators and independent measurement of achievements

RESULT BASED FINANCING Total Operation Cost : Investment tranche(IT) + Counterpart (CN) Assignment SM2015 : Investment Tranche (IT) + Performance Tranche (PT)

Performance Matrix to 5 years If countries meet the targets set, they receive the performance award and proceed to prepare a second operation. If countries don’t perform, they receive technical assistance and a second chance Operation 1 Operation 2 Operation 3 PERFORMANCE MATRIX

PERFORMANCE EVALUATION Country is reimbursed 50% of its contribution Free to use within the health sector Country proceeds to the higher targets set for the following months If goals are met Country is provided with technical assistance Same goals maintained for next operation 2 strike policy If goals are not met

Household and facility surveys to establish baselines, targets and attained results. Completely external verification Rigorous impact evaluations planned in some countries. Process documentation and qualitative research to complement quantitative assessments. Countries report to a performance dashboard publicly available on line. MEASUREMENT, VERIFICATION AND LEARNING

REFLECTIONS

Hands off approach if countries achieve results. Technical assistance mandated if results are weak. Pro- poor focus Requiring that governments co-finance the initiative may contribute to sustainability Country level incentives may catalyze broad system changes needed to achieve results A NEW WAY TO PROVIDE AID?

Will performance rewards to national governments cascade down to affect the actions of service providers and households? Is relying on completely external verification a missed opportunity to strengthen country generation and use of health information for decisions? Are 18 month performance periods long enough to see significant improvements in results? TO PONDER

VISITE OUR WEB “An innovative public/private partnership to reduce health equity gaps in Mesoamerica”