1. 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

2. 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?

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

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

5. 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.

6. 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

7. 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

8. Thank You