1. Peter Hansen Perspectives on Performance Based Financing within the GAVI Alliance Clermont-Ferrand, 11 May 2011

2. Clermont-Ferrand 11 May 2011 Performance Based Financing (PBF) within the GAVI Alliance  Operates on two main levels:  Between GAVI and national government (‘aid’): Immunisation Services Support (ISS)  Between national government and lower levels, civil society and communities (‘financing’): Health Systems Strengthening  Future directions  Grant monitoring framework  Health Systems Funding Platform  Incentives for Routine Immunisation Strengthening (IRIS) 1

3. Clermont-Ferrand 11 May 2011 Draft Grant Monitoring Framework 2

4. Clermont-Ferrand 11 May 2011 Health Systems Funding Platform  ‘Financing’ – platform to be used to finance PBF initiatives within many countries, based on national health strategies  ‘Aid’ – options/modalities are in development  Options to be explored to deliver all cash based programmes within GAVI through platform 3

5. Clermont-Ferrand 11 May 2011 IRIS  Objectives  Increase routine immunisation coverage  Increase equity in immunisation coverage  Structure  National governments submit applications to GAVI  Must specify detailed plan describing how incentives would be pushed down to lower levels of the system 4

6. Clermont-Ferrand 11 May 2011 IRIS  Builds on ISS design and lessons learned  Key Changes  Incentives distributed to lower levels of system  Portion of grant “fixed” (process measures) and portion “at risk” (outcome measures) each year  Performance payments linked to coverage (and possibly equity) rather than number of children immunised  Enhanced and independent validation of results, linked to WHO/UNICEF estimates 5

7. Clermont-Ferrand 11 May 2011 Payments under IRIS – hypothetical example 6

8. Clermont-Ferrand 11 May 2011 What has worked in using PBF within GAVI?  PBF has helped catalyse achievement of better results in many countries  Positive feedback from countries  Clarity, flexibility, autonomy, ownership, encourages innovation, low transaction costs and reporting burden  Reduced transaction costs at global level  Leaner model means more money to finance results at country level  ISS pathfinder effect 7

9. Clermont-Ferrand 11 May 2011 Lessons learned  If incentives are wrong, potential to distort behaviour  Be explicit about theory of change and put it to the test  Actively identify and document unintended consequences  Need to ensure appropriate balance between:  Data integrity, country ownership and capacity strengthening  Quantitative rules and responsiveness to context  Predictability and results orientation  Rewarding good performance and addressing needs of low performers 8

10. Clermont-Ferrand 11 May 2011 9