RESULTS-BASED FINANCING Health Results Innovation Trust Fund Clermont-Ferrand, France December 17-18, 2009 Petra Vergeer Health Specialist Health, Nutrition and Population Unit

Health Results Innovation Trust Fund (HRITF) Principles Objective Current Activities ( ) Expansion ( )

Principles The Health Results Innovation Trust Fund aims to be consistent with the International Health Partnership (IHP+) principles, working with development partners and countries to build and use country systems for results, wherever possible.

Objective Support RBF approaches for achievement of the health- related MDGs, particularly focusing on MDGs 4 and 5. Aims: o support design, implementation and evaluation of RBF mechanisms o develop and disseminate the evidence base for implementing successful RBF mechanisms o build national institutional capacity to scale-up and sustain the RBF mechanisms, within the national health strategy and system

Current Activities ( ) Countries with RBF Pilot Projects (8) o Afghanistan; Benin; DRC; Eritrea; Ghana; Kyrgyz Republic; Rwanda; Zambia Impact Evaluation – Start-up Phase Seed Grants (6) o India; Lesotho; Liberia; Mongolia; Sierra Leone; Tajikistan Analytical work o Tool Kit for RBF Supply-side (Rwanda experience); o Knowledge Product - Verification of performance linked to incentive o Knowledge Product - Role of Non-State Actors in RBF RBF Website – Open Platform for Knowledge Co-chair RBF Inter-Agency Working Group

Expansion Initial funding Norway US$95 million Norway and the United Kingdom additional support to the HRITF in the amount of US$440 million equivalent for the period 2009 – 2020

HRITF – Future Country Identification Identification of countries will be guided by the following criteria: 49 LICs, particularly with a high burden of disease for health-related MDGs, focusing on MDGs 4 and 5 Commitments to: o IHP+ principles and opportunities to work closely through the new Health Systems Funding platform o Global Consensus on Maternal, Newborn and Child Health (the ‘Consensus’)—including removing barriers to access, with services for women and children free at the point of use where countries choose o And track record to implementing equitable strategies that will demonstrate an increase in the proportion of health services consumed by the poor, women and children o Scaling-up RBF, learning-by-doing and evaluation Potential for IDA-financed HNP projects, particularly sector reform operations A positive track record in the management of external funds to support HSS

HRITF Activities Sharing lessons learnt (documenting implementation and impact evaluation through RBF website, conferences, etc.) RBF Seed Grants Independent External Evaluation of the Trust Fund

HRITF Activities Buy-downs and Buy-ups  Buy-downs involve the provision by donors of committed funding to ‘buy-down’, or pay for all, or part of a Bank loan/credit on behalf of the government, once results are achieved.  Buy-ups support IDA countries that receive grant financing, whereby additional donor financing is provided based on results.  Proposal covering the rationale for buy-downs and buy- ups, and other approaches that can leverage additional resources and incentivize performance for the national health sector.

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