Results – Based Financing (RBF) in Health Presentation by Gaston Sorgho, HD Sector Leader – Central Africa World Bank AFRICA - HNP

Inputs Outputs Activities Traditional Financing Results Based Financing World Bank - AFR Health Nutrition Population

Paying for results: Taking quality into account Measuring the quantity of services produced by the health facility; Quarterly measurement of the quality of services the facility delivers; Quantity * Unit price per service * Quality Index = Payment Adjustment made for remoteness or other difficulty. World Bank - AFR Health Nutrition Population

ServiceNumber Provided Unit price Total Earned Child fully vaccinated100$5$500 Skilled birth attendance20$10$200 Curative care <5 years1,000$0.5$500 TOTAL$1,200 Remoteness Bonus+50%$1,800 Quality Correction60%$1,080 Example of Results Based Financing (RBF) in a Health Facility World Bank - AFR Health Nutrition Population

ServiceNumber Provided Unit price Total Earned Child fully vaccinated100$5$500 Skilled birth attendance20$10$200 Curative care <5 years1,000$0.5$500 TOTAL$1,200 Remoteness Bonus+50%$1,800 Quality Correction60%$1,080 Deciding on which services to include, i.e., which are the priorities

World Bank - AFR Health Nutrition Population ServiceNumber Provided Unit price Total Earned Child fully vaccinated100$5$500 Skilled birth attendance20$10$200 Curative care <5 years1,000$0.5$500 TOTAL$1,200 Remoteness Bonus+50%$1,800 Quality Correction60%$1,080 Setting the unit price for each service is complicated but prices can be adjusted

World Bank - AFR Health Nutrition Population ServiceNumber Provided Unit price Total Earned Child fully vaccinated100$5$500 Skilled birth attendance20$10$200 Curative care <5 years1,000$0.5$500 TOTAL$1,200 Remoteness Bonus+50%$1,800 Quality Correction60%$1,080 Verifying that the claimed quantity of services were actually delivered requires care & a few approaches

World Bank - AFR Health Nutrition Population ServiceNumber Provided Unit price Total Earned Child fully vaccinated100$5$500 Skilled birth attendance20$10$200 Curative care <5 years1,000$0.5$500 TOTAL$1,200 Remoteness Bonus+50%$1,800 Quality Correction60%$1,080 Measuring quality of care is an important challenge

Example of a Quantitative Checklist to determine Quality of Care Score Date of Visit MaiAoutNovFev. Availability of Drugs (0-10)77810 Presence of staff (0-10)5689 SNIS implementation (0-10)3355 TB Case Detection Rate (0-10)58910 Cleanliness of Health Center67810 Quality of delivery care (0-10)6778 Outreach activities (0-10)2568 TOTAL SCORE (out of 70) TOTAL PERCENT

World Bank - AFR Health Nutrition Population ServiceNumber Provided Unit price Total Earned Child fully vaccinated100$5$500 Skilled birth attendance20$10$200 Curative care <5 years1,000$0.5$500 TOTAL$1,200 Remoteness Bonus+50%$1,800 Quality Correction60%$1,080 Remoteness bonus reflects the fact that some facilities will face bigger challenges in attracting patients

ServiceNumber Provided Unit price Total Earned Child fully vaccinated100$5$500 Skilled birth attendance20$10$200 Curative care <5 years1,000$0.5$500 TOTAL$1,200 Remoteness Bonus+50%$1,800 Quality Correction60%$1,080 Example of Results Based Financing (RBF) in a Health Facility World Bank - AFR Health Nutrition Population

Example of what can the facility do with the $1,080 Health facility operation costs(about 40%): -Maintenance and repair -Consumables -Drugs -Outreach -Other elements related to improving quality Performance bonus to health workers (about 60%) –criteria are defined World Bank - AFR Health Nutrition Population