A presentation by Dinesh Nair, delivered during "Transforming Health Systems Through Results-Based Financing," an event held during the Third Global Symposium on Health Systems Research in Cape Town on September 30, 2014. This event was hosted by the Health Results Innovation Trust Fund at The World Bank, in partnership with the PBF Community of Practice in Africa.

1. Transforming Health Systems Through
Results Based Financing
Learning from Implementation & Impact
Evaluations
Dinesh Nair, Sr Health Specialist

2. Making an impact around the world

3. An expanding RBF Portfolio
79
160
121
177 175
36 projects
249 263
321
361
285
148
60
4
11
12
24 41
63
105
105
105
50
13
5
450
400
350
300
250
200
150
100
50
-
FY09 FY10 FY11 FY12 FY13 FY14 FY15 FY16 FY17 FY18 FY19 FY20
Disbursements, US$ million
IDA HRITF
Note: Fiscal Year is July 1 through June 30. Projections for FY15-FY20 are based on total commitments and the
expected closing date of the projects.

4. Early Evidence of
Impact

5. Rwanda: Increasing Coverage and Quality
5

6. Improving Efficiency in Zambia & Zimbabwe
6

8. Using Operational Data

9. Operational data informs operations and learning
• To monitor progress and assess RBF’s contributions to
health system’s goals
• To monitor what money is spent on
• To identify areas for further inquiries and mid-course
corrections
• To assess the effects of RBF approaches
• To facilitate cross-country learning and sharing of
experience

10. The dashboards show real time performance
and amount spent, down to the facility level.

11. Learning from Implementation

12. 1
2

13. Evaluating RBF
Programs

14. Growth of the IE portfolio
• 36 impact evaluations + 5 in pipeline
• 5 program assessments including 3 completed
• High increase in overall number = many at design stage
• Impact evaluations also progressing to final stage
• Endline surveys planned for 2014: Zambia, Zimbabwe

15. Diversity of Themes
Intervention evaluated Countries
Supply-side RBF payments Afghanistan, Argentina, Armenia, Benin, Burkina Faso, Burundi,
Cameroon, Central African Republic, Democratic Republic of
Congo, Djibouti, Ethiopia, Gambia, Haiti, Kenya, Kyrgyz Republic,
Lao PDR, Lesotho, Liberia, Nigeria, Pakistan, Rwanda, Senegal,
Sierra Leone, Tajikistan, Turkey, Yemen, Zambia, Zimbabwe
Demand-side RBF payments Gambia, Lao PDR, Nigeria, Pakistan, Rwanda, Senegal, Yemen,
Zimbabwe
Community-Based RBF Gambia, Haiti, India, Senegal, Rwanda
RBF for quality of care Afghanistan, Argentina, Benin, Brazil, Cambodia, Cameroon,
Central African Republic, China, Haiti, Kyrgyz Republic, Lao PDR,
Nigeria, Senegal, Tajikistan, Turkey, Zambia, Zimbabwe
RBF in hospitals Afghanistan, Argentina, Burundi, China, India, Kyrgyz Republic, Lao
PDR, Liberia, Nigeria, Philippines, Senegal, Sierra Leone, Turkey
Additional financing Benin, Nigeria, Zambia, Zimbabwe
Differential incentive levels Central African Republic, China
Enhanced monitoring and
Cameroon, Kyrgyz Republic
supervision
RBF and training of providers Zimbabwe
Process vs. output Brazil
Negative Incentives (sanctions) Turkey
1
5

16. Innovations

17. Supply Chain

18. Quality of Care

19. Community & Demand Side RBF

20. Knowledge Sharing & Capacity
Building

21. Scale Up

22. THANK YOU