1. Monitoring Results Rena Eichler, PhD Broad Branch Associates
Results Based Financing to Reduce
Maternal, Newborn, and Child Mortality,
(Session 10; October 23, 2008)

2. Imagine…
It’s the end of a quarter, what information do you need to know if you should pay recipients for results?
Did they achieve performance targets?
Are there any untended effects of the incentive scheme on non-rewarded services?
Any perverse effects on rewarded services?
Who needs help?

3. Functions of your monitoring system
Produces information to let you know how much to pay to whom.
Produces information to inform who is lagging and needs help.
Produces information on performance trends for both rewarded and other services.

4. “Levels” of Monitoring
RBF Unit in the Ministry of Health
Region 1
District A
District B
Facility 1
Facility 2
Facility 3
Facility 4

5. Consider the needed staffing and structures
Facility to District :
Facility collects, verifies and reports data (often based on existing HMIS) on services provided.
District collects, inputs, verifies and analyzes facility data.
District determines payment to facilities.
District assesses district performance.
Identifies low performers in need of help.
Develops and implements strategy to support improvement.
District provides feedback on performance to facilities.

6. District to Region Districts report to Regions
Regions verify district reported results.
Regions determine payment to districts?
Regions assess district performance.
Identify low performers in need of help.
Develop and implement strategy to support improvement.
Regions provide feedback on performance to districts.

7. Region to Center
Center aggregates performance data for entire country.
Center determines payment to regions or districts.
Tracks progress toward attainment of national goals.
Identifies unintended effects and implements changes policy to address them if needed.
Identifies challenges and determines strategies to improve.

8. Is this something new?
Most systems are “supposed” to work this way now!
Do they?
If not, why not?

9. Imagine if every month a district could see this… (adapted from the RBF management tool created for the RBF pilot in Zambia)

10. Top and bottom 5

11. Range of achievement across facilities for each indicator

12. And detail for each indicator

13. And for each facility

14. Imagine Information and feedback flows up AND down.
All levels have the information needed to take action to improve.
Information to trigger payment is timely and reliable.
The National Ministry of Health (or other lead) knows what is working and what is not and can make changes based on solid information.

15. Some considerations Minimize burden:
Whenever possible, use existing data collection and reporting systems.
Whenever possible, enhance capabilities of existing staff.
Assure resources (people, money, systems) for effective monitoring.
Don’t scrimp on training.

16. THANK YOU!