SlideShare une entreprise Scribd logo
1  sur  27
Télécharger pour lire hors ligne
Taking Results Based Financing from Scheme
to System: a multi-country study
Zubin Shroff & Bruno Meessen
CoP Webinar
January 20th 2017
asd
Presentation Outline
Part 1:
• Our research
• Scaling up is multidimensional
• Scaling up is a four phase process
Part 2:
• Moving from one phase to the next: context, actors,
policy content and processes
• Larger lessons learnt from the cross-country research
asd
Main question: what are the enablers and
barriers for the scale-up of RBF schemes?
Armenia Cameroon Macedonia Tanzania
Burundi Chad Mozambique Uganda
Cambodia Kenya Rwanda
• Mainly qualitative methods
• Iterative
Documentary
review
Timeline
development
Key informant
interviews
Source: Sieleunou et al. 2015
asd
Idea #1: Scale-up occurs over 5 dimensions
Dimension Content
Population Coverage Geographical coverage, age and income groups
covered, total people covered
Service Coverage Number, types, level, affiliation of services
Health System
Integration &
Institutionalization
Connections with the six building blocks of the health
system
Cross-sectoral diffusion Changes outside the health sector
Knowledge & Ideas Status of the knowledge
asd
An illustration (1)
0
1
2
3
4
5
Population Coverage
Service Coverage
IntegrationCross sector diffusion
Knowledge
asd
An illustration (2)
asd
Generation
(from idea to project)
Adoption
(from project to
program)
Institutionalisation
(from program to
policy)
Expansion
(from policy to
system)
Idea #2: the four phase model of scale-up
• Reason: scaling up require some key resoures/currencies and
these resources are themselves partly an outcome of the
process.
• This is an emerging pattern, not a law.
asd
Phase 1: Generation
• Movement from initial idea to one or more pilots
• End point: pilot implemented as proof of concept
Generation
(from idea to project)
Adoption
(from project to
program)
Institutionalisation
(from program to
policy)
Expansion
(from policy to
system)
asd
Phase 2: Adoption
• Movement from pilot project to a national ‘program’: a coherent and
identifiable set of institutional arrangements organising the transfer of
resources to service providers is in place (contracts, guidelines…)
• Increased coverage in terms of administrative units implementing and
hence people covered → a heavy operational stage
• End point: a national unit, trainers & digital tools are in place to roll out
(knowledge!)
Generation
(from idea to project)
Adoption
(from project to
program)
Institutionalisation
(from program to
policy)
Expansion
(from policy to
system)
asd
Phase 3: Institutionalisation
• This refers to the transition from a program to a national policy
• Integration within the six ‘building blocks’.
• Governance: A stated objective of national strategic documents and decrees
• Finance: public funding and harmony with other financing mechanisms.
• End point: PBF is an integrated provider payment mechanism for
whole country
Generation
(from idea to project)
Adoption
(from project to
program)
Institutionalisation
(from program to
policy)
Expansion
(from policy to
system)
Phase 4: Expansion
• This refers to the transition from a mechanism to a set of key
principles informing the design and implementation of public
policy in the health sector but, also beyond.
• Paying for results and provider autonomy inform fields like
education
Generation
(from idea to project)
Adoption
(from project to
program)
Institutionalisation
(from program to
policy)
Expansion
(from policy to
system)
asd
Generation Adoption
Institutionalis
ation Expansion
FINDINGS
asd
Sample: countries at different stages…
Moving Across Phases- Phase 1: Generation
• Contextual factors-
– Interaction of global (aid effectiveness), regional (influence of Rwanda)
and national context (RBF as a solution to address a met need)
– Previous experience with organizational and financing reforms of the
health systems- voucher schemes, direct cash transfers
• Actors
– Seminal Role of Knowledge brokers or Health Financing Experts, along
with international agencies (bilaterals, multilaterals, faith based) in sowing
the seed
• Content
– Broad agreement on general principles and practices among community
of knowledge brokers
– Funding agencies had some role in determining focus, over time govts
played increasingly important role
Moving Across Phases- Phase 2: Adoption
• Contextual factors-
– National context relatively more important; pre-existing autonomous
institutions; enabling legal frameworks and changes
– National agenda of transparency and results hastens process
• Actors
– International agencies continue to be important (funding and technical
assistance); though usually one agency takes dominant role (Rwanda,
Cameroon, Kenya, Armenia)
– Role for national policy entrepreneurs, from MOH or pilot programs
– Development of critical mass of national level practitioners
• Process
– Coordination and alignment of stakeholders, task force
Moving Across Phases- Phase 3: Institutionalization
• High Level of continuity between this and previous stage, still needs active management
• Contextual factors-
– Legal frameworks continue to evolve
– Enabled by increased security of funding, especially from domestic sources
• Actors
– Increasing political and technical leadership of MOH and national RBF experts
– National ownership goes beyond the MOH, the ‘coalition of change’- MOF, local
govts, social security agency
• Content
– Greater country level influence on design, reflecting increased domestic resources
and technical leadership (Cambodia-internal contracting, Rwanda-cPBF)
Moving Across Phases- Phase 4:
Expansion
• Contextual factors-
– Knowledge on integration in health informs attempts to extend
PBF principles to other sectors
• Actors
– National level expertise and high level political support to take
forward PBF principles
• Content
– Variations develop in extending PBF principles to other sectors
including local government administration
LESSONS
Five broad lessons
• Lesson 1: Some countries stay stuck in phase 1
• Lesson 2: Rhetoric and framing matter
• Lesson 3: Scale up requires a chain of actors
• Lesson 4: Look beyond the label for content
when examining interactions
• Lesson 5: Balance technically best against
politically feasible
Lesson 1: Why some countries get stuck in
Phase 1
• A pilot is not a pilot. Successful pilot doesn’t ensure scale up
– How it is framed- disease focused or health systems strengthening
(Mozambique vs Cameroon)
– Who implements it- entity a) largely focused on a single disease, b) with
political, technical, financial influence at country level
– Which level of government is engaged ? Engagement at the district or
provincial level initial rapid uptake, but to national level may then be more
challenging (Mozambique, Uganda)
– Where it is housed in national government apparatus
– Is it implemented largely outside the public system?
– More pilots are not always better
→ Forthcoming webinar: Kiendrébéogo et al 2017
Lesson 2: Rhetoric and Framing Matter
• RBF programs have been put forth as transparency
enhancing and part of a results agenda
• This works in some settings (Cameroon and Rwanda), but
may not be universally the case; potential to directly
confront interests keen on status quo
• Needs analysing political situation to see if this is most
appropriate strategy and otherwise looking for
individuals and groups at national level who can help
place transparency and results on the agenda, in other
words-create the window of opportunity
Lesson 3: Scale up needs a chain of actors
• Seen how dominant actors varied by stage – each control a
key resource for the specific stage
• Invest in building your support coalition – anticipate and
involve at an early stage
• As stakeholders change, so do their incentives. Incentives for
provincial level governments to adopt PBF pilots may be
completely different from national governments
• Adapt your framing - initial PBF pilot framed as solving an
urgent need, issues of sustainability may not be immediately
important, but as you progress this becomes more important
Lesson 4: Look beyond the label and at the
content of other reforms
• Decentralization and increased autonomy, while enabling
to PBF programs in a number of ways, also alter who
decides what, something that changes incentives for
different players
• Devolution in Kenya- increased accountability buy taking
decision-making closer to people, but increased chance
of reduced spending on public goods and more on visible
things like infrastructure
Lesson 5: Balance the technically best
program against what is politically
feasible
• A technically sub-optimal intervention may be the right
choice when weighed against increased government buy
in and therefore likelihood of long term sustainability
• Cambodia example of choice of program, government
wanted greater control and chose model of contracting
enabling this
Thank You

Contenu connexe

Tendances

Costing Violence against Women and Girls in Asia and the Pacific: A Snapshot
Costing Violence against Women and Girls in Asia and the Pacific: A Snapshot Costing Violence against Women and Girls in Asia and the Pacific: A Snapshot
Costing Violence against Women and Girls in Asia and the Pacific: A Snapshot Gobernabilidad
 
Implementing regional-policies-effectively
Implementing regional-policies-effectivelyImplementing regional-policies-effectively
Implementing regional-policies-effectivelyOECD Governance
 
New Directions in the Quality of Aid, revised 5.18.11
New Directions in the Quality of Aid, revised 5.18.11New Directions in the Quality of Aid, revised 5.18.11
New Directions in the Quality of Aid, revised 5.18.11icgfmconference
 
D2 am-s4 - luiz de mello - oecd - rev2
D2 am-s4 - luiz de mello - oecd - rev2D2 am-s4 - luiz de mello - oecd - rev2
D2 am-s4 - luiz de mello - oecd - rev2OECD Governance
 
Day 4 emerging role of hpro ea
Day 4 emerging role of hpro eaDay 4 emerging role of hpro ea
Day 4 emerging role of hpro eaea-imcha
 
Gender Budgeting in Israel - Amir Levi, Israel
Gender Budgeting in Israel - Amir Levi, IsraelGender Budgeting in Israel - Amir Levi, Israel
Gender Budgeting in Israel - Amir Levi, IsraelOECD Governance
 
Session Harmonization 2c - Tamene Chaka
Session Harmonization 2c -  Tamene ChakaSession Harmonization 2c -  Tamene Chaka
Session Harmonization 2c - Tamene ChakaIRC
 
Gavi co financing evaluation report presentation
Gavi co financing evaluation report presentationGavi co financing evaluation report presentation
Gavi co financing evaluation report presentationDimitrios Gouglas
 
Wider presentation finnish un_association_121217
Wider presentation finnish un_association_121217Wider presentation finnish un_association_121217
Wider presentation finnish un_association_121217UNU-WIDER
 
Fi strategies-global-trends-and-lessons-from-afi-by-klaus-prochaska
Fi strategies-global-trends-and-lessons-from-afi-by-klaus-prochaskaFi strategies-global-trends-and-lessons-from-afi-by-klaus-prochaska
Fi strategies-global-trends-and-lessons-from-afi-by-klaus-prochaskaDr Lendy Spires
 
REDD+ Benefits Sharing
REDD+ Benefits SharingREDD+ Benefits Sharing
REDD+ Benefits SharingCIFOR-ICRAF
 
Gender Budgeting - Ronnie Downes, Elena Gentili, OECD
Gender Budgeting - Ronnie Downes, Elena Gentili, OECDGender Budgeting - Ronnie Downes, Elena Gentili, OECD
Gender Budgeting - Ronnie Downes, Elena Gentili, OECDOECD Governance
 
Accountable and effective development cooperation in a post 2015 era
Accountable and effective development cooperation in a post 2015 eraAccountable and effective development cooperation in a post 2015 era
Accountable and effective development cooperation in a post 2015 eraDr Lendy Spires
 
Governance of the Extractive Industries in Africa: Survey of donor-funded ass...
Governance of the Extractive Industries in Africa: Survey of donor-funded ass...Governance of the Extractive Industries in Africa: Survey of donor-funded ass...
Governance of the Extractive Industries in Africa: Survey of donor-funded ass...Dr Lendy Spires
 
Questionnaire on an accountability framework for the post 2015 agenda a synth...
Questionnaire on an accountability framework for the post 2015 agenda a synth...Questionnaire on an accountability framework for the post 2015 agenda a synth...
Questionnaire on an accountability framework for the post 2015 agenda a synth...Dr Lendy Spires
 
Multi-stakeholder partnerships to finance and improve food security and nutri...
Multi-stakeholder partnerships to finance and improve food security and nutri...Multi-stakeholder partnerships to finance and improve food security and nutri...
Multi-stakeholder partnerships to finance and improve food security and nutri...Francois Stepman
 
TRACKING-USAIDS-EFFORTS-JAN-2015
TRACKING-USAIDS-EFFORTS-JAN-2015TRACKING-USAIDS-EFFORTS-JAN-2015
TRACKING-USAIDS-EFFORTS-JAN-2015Sylvain Browa
 

Tendances (20)

Costing Violence against Women and Girls in Asia and the Pacific: A Snapshot
Costing Violence against Women and Girls in Asia and the Pacific: A Snapshot Costing Violence against Women and Girls in Asia and the Pacific: A Snapshot
Costing Violence against Women and Girls in Asia and the Pacific: A Snapshot
 
Implementing regional-policies-effectively
Implementing regional-policies-effectivelyImplementing regional-policies-effectively
Implementing regional-policies-effectively
 
New Directions in the Quality of Aid, revised 5.18.11
New Directions in the Quality of Aid, revised 5.18.11New Directions in the Quality of Aid, revised 5.18.11
New Directions in the Quality of Aid, revised 5.18.11
 
2015 ReSAKSS Conference – Day 1 - Elliot Mghenyi
2015 ReSAKSS Conference – Day 1 - Elliot Mghenyi2015 ReSAKSS Conference – Day 1 - Elliot Mghenyi
2015 ReSAKSS Conference – Day 1 - Elliot Mghenyi
 
D2 am-s4 - luiz de mello - oecd - rev2
D2 am-s4 - luiz de mello - oecd - rev2D2 am-s4 - luiz de mello - oecd - rev2
D2 am-s4 - luiz de mello - oecd - rev2
 
Day 4 emerging role of hpro ea
Day 4 emerging role of hpro eaDay 4 emerging role of hpro ea
Day 4 emerging role of hpro ea
 
infob106
infob106infob106
infob106
 
Gender Budgeting in Israel - Amir Levi, Israel
Gender Budgeting in Israel - Amir Levi, IsraelGender Budgeting in Israel - Amir Levi, Israel
Gender Budgeting in Israel - Amir Levi, Israel
 
Session Harmonization 2c - Tamene Chaka
Session Harmonization 2c -  Tamene ChakaSession Harmonization 2c -  Tamene Chaka
Session Harmonization 2c - Tamene Chaka
 
Gavi co financing evaluation report presentation
Gavi co financing evaluation report presentationGavi co financing evaluation report presentation
Gavi co financing evaluation report presentation
 
Wider presentation finnish un_association_121217
Wider presentation finnish un_association_121217Wider presentation finnish un_association_121217
Wider presentation finnish un_association_121217
 
Fi strategies-global-trends-and-lessons-from-afi-by-klaus-prochaska
Fi strategies-global-trends-and-lessons-from-afi-by-klaus-prochaskaFi strategies-global-trends-and-lessons-from-afi-by-klaus-prochaska
Fi strategies-global-trends-and-lessons-from-afi-by-klaus-prochaska
 
REDD+ Benefits Sharing
REDD+ Benefits SharingREDD+ Benefits Sharing
REDD+ Benefits Sharing
 
Gender Budgeting - Ronnie Downes, Elena Gentili, OECD
Gender Budgeting - Ronnie Downes, Elena Gentili, OECDGender Budgeting - Ronnie Downes, Elena Gentili, OECD
Gender Budgeting - Ronnie Downes, Elena Gentili, OECD
 
Accountable and effective development cooperation in a post 2015 era
Accountable and effective development cooperation in a post 2015 eraAccountable and effective development cooperation in a post 2015 era
Accountable and effective development cooperation in a post 2015 era
 
Governance of the Extractive Industries in Africa: Survey of donor-funded ass...
Governance of the Extractive Industries in Africa: Survey of donor-funded ass...Governance of the Extractive Industries in Africa: Survey of donor-funded ass...
Governance of the Extractive Industries in Africa: Survey of donor-funded ass...
 
Day 2: Concluding remarks
Day 2: Concluding remarksDay 2: Concluding remarks
Day 2: Concluding remarks
 
Questionnaire on an accountability framework for the post 2015 agenda a synth...
Questionnaire on an accountability framework for the post 2015 agenda a synth...Questionnaire on an accountability framework for the post 2015 agenda a synth...
Questionnaire on an accountability framework for the post 2015 agenda a synth...
 
Multi-stakeholder partnerships to finance and improve food security and nutri...
Multi-stakeholder partnerships to finance and improve food security and nutri...Multi-stakeholder partnerships to finance and improve food security and nutri...
Multi-stakeholder partnerships to finance and improve food security and nutri...
 
TRACKING-USAIDS-EFFORTS-JAN-2015
TRACKING-USAIDS-EFFORTS-JAN-2015TRACKING-USAIDS-EFFORTS-JAN-2015
TRACKING-USAIDS-EFFORTS-JAN-2015
 

En vedette

FBR / Passer de l'idée au système
FBR / Passer de l'idée au systèmeFBR / Passer de l'idée au système
FBR / Passer de l'idée au systèmeCOP_HHA
 
Le financement de la CSU en Afrique: le défi de la fragmentation
Le financement de la CSU en Afrique: le défi de la fragmentationLe financement de la CSU en Afrique: le défi de la fragmentation
Le financement de la CSU en Afrique: le défi de la fragmentationagkelley514
 
Pres 4 Introduction aux concepts d'organisation apprenante
Pres 4 Introduction aux concepts d'organisation apprenante Pres 4 Introduction aux concepts d'organisation apprenante
Pres 4 Introduction aux concepts d'organisation apprenante agkelley514
 
Setting a Path for Improved Health Outcomes RBF
Setting a Path for Improved Health Outcomes RBFSetting a Path for Improved Health Outcomes RBF
Setting a Path for Improved Health Outcomes RBFRBFHealth
 
Strategic purchasing - 30 september
Strategic purchasing - 30 september Strategic purchasing - 30 september
Strategic purchasing - 30 september COP_HHA
 
Annual Results and Impact Evaluation Workshop for RBF - Day One - Le Financem...
Annual Results and Impact Evaluation Workshop for RBF - Day One - Le Financem...Annual Results and Impact Evaluation Workshop for RBF - Day One - Le Financem...
Annual Results and Impact Evaluation Workshop for RBF - Day One - Le Financem...RBFHealth
 

En vedette (8)

Conference academique IMT
Conference academique IMTConference academique IMT
Conference academique IMT
 
FBR / Passer de l'idée au système
FBR / Passer de l'idée au systèmeFBR / Passer de l'idée au système
FBR / Passer de l'idée au système
 
Jalons p mercenier_141205
Jalons p mercenier_141205Jalons p mercenier_141205
Jalons p mercenier_141205
 
Le financement de la CSU en Afrique: le défi de la fragmentation
Le financement de la CSU en Afrique: le défi de la fragmentationLe financement de la CSU en Afrique: le défi de la fragmentation
Le financement de la CSU en Afrique: le défi de la fragmentation
 
Pres 4 Introduction aux concepts d'organisation apprenante
Pres 4 Introduction aux concepts d'organisation apprenante Pres 4 Introduction aux concepts d'organisation apprenante
Pres 4 Introduction aux concepts d'organisation apprenante
 
Setting a Path for Improved Health Outcomes RBF
Setting a Path for Improved Health Outcomes RBFSetting a Path for Improved Health Outcomes RBF
Setting a Path for Improved Health Outcomes RBF
 
Strategic purchasing - 30 september
Strategic purchasing - 30 september Strategic purchasing - 30 september
Strategic purchasing - 30 september
 
Annual Results and Impact Evaluation Workshop for RBF - Day One - Le Financem...
Annual Results and Impact Evaluation Workshop for RBF - Day One - Le Financem...Annual Results and Impact Evaluation Workshop for RBF - Day One - Le Financem...
Annual Results and Impact Evaluation Workshop for RBF - Day One - Le Financem...
 

Similaire à Taking RBF From Scheme to System

Crg presentation to technical assistance providers
Crg presentation to technical assistance providersCrg presentation to technical assistance providers
Crg presentation to technical assistance providersclac.cab
 
Community, rights, gender and the new funding model
Community, rights, gender and the new funding modelCommunity, rights, gender and the new funding model
Community, rights, gender and the new funding modelclac.cab
 
Budgeting and investment management in post conflict countries
Budgeting and investment management in post conflict countriesBudgeting and investment management in post conflict countries
Budgeting and investment management in post conflict countriesJean-Marc Lepain
 
Monitoring and evaluation and the policy process
Monitoring and evaluation and the  policy process   Monitoring and evaluation and the  policy process
Monitoring and evaluation and the policy process pasicUganda
 
Institutionalizing Performance Budgeting: Key Institutions and Actors - Roles...
Institutionalizing Performance Budgeting: Key Institutions and Actors - Roles...Institutionalizing Performance Budgeting: Key Institutions and Actors - Roles...
Institutionalizing Performance Budgeting: Key Institutions and Actors - Roles...EUROsociAL II
 
What is Joint Learning?
What is Joint Learning?What is Joint Learning?
What is Joint Learning?HFG Project
 
NFM_master deck
NFM_master deckNFM_master deck
NFM_master deckclac.cab
 
Cies 2015 global literacy & going to scale sc presentation 11march2015
Cies 2015 global literacy & going to scale sc presentation 11march2015Cies 2015 global literacy & going to scale sc presentation 11march2015
Cies 2015 global literacy & going to scale sc presentation 11march2015Cecilia Ochoa
 
Fostering research for policy and practitioners lessons and opportunities
Fostering research for policy and practitioners lessons and opportunitiesFostering research for policy and practitioners lessons and opportunities
Fostering research for policy and practitioners lessons and opportunitiesUNICEF Office of Research - Innocenti
 
Day 1 sat presentation re nfm feb 28
Day 1 sat presentation re nfm feb 28 Day 1 sat presentation re nfm feb 28
Day 1 sat presentation re nfm feb 28 clac.cab
 
Leadership for Affordable Housing Evaluation Study
Leadership for Affordable Housing Evaluation StudyLeadership for Affordable Housing Evaluation Study
Leadership for Affordable Housing Evaluation Studymjbinstitute
 
Introducing Policy Implementation and Evaluation.
  Introducing Policy Implementation and Evaluation.  Introducing Policy Implementation and Evaluation.
Introducing Policy Implementation and Evaluation.pasicUganda
 
Country dialog training external
Country dialog training externalCountry dialog training external
Country dialog training externalclac.cab
 
Country dialogue training external
Country dialogue training externalCountry dialogue training external
Country dialogue training externalclac.cab
 
Reevaluasi Metode Penentuan Prioritas Layanan Pemerintah
Reevaluasi Metode Penentuan Prioritas Layanan Pemerintah Reevaluasi Metode Penentuan Prioritas Layanan Pemerintah
Reevaluasi Metode Penentuan Prioritas Layanan Pemerintah Fahrul Azmi
 
Transferring the purchasing role from international to national organizations...
Transferring the purchasing role from international to national organizations...Transferring the purchasing role from international to national organizations...
Transferring the purchasing role from international to national organizations...valéry ridde
 
May Pathfinder Listening and Learning event breakout session: Consortia auth...
May Pathfinder Listening and Learning  event breakout session: Consortia auth...May Pathfinder Listening and Learning  event breakout session: Consortia auth...
May Pathfinder Listening and Learning event breakout session: Consortia auth...healthandcare
 

Similaire à Taking RBF From Scheme to System (20)

Crg presentation to technical assistance providers
Crg presentation to technical assistance providersCrg presentation to technical assistance providers
Crg presentation to technical assistance providers
 
Community, rights, gender and the new funding model
Community, rights, gender and the new funding modelCommunity, rights, gender and the new funding model
Community, rights, gender and the new funding model
 
Budgeting and investment management in post conflict countries
Budgeting and investment management in post conflict countriesBudgeting and investment management in post conflict countries
Budgeting and investment management in post conflict countries
 
Monitoring and evaluation and the policy process
Monitoring and evaluation and the  policy process   Monitoring and evaluation and the  policy process
Monitoring and evaluation and the policy process
 
Institutionalizing Performance Budgeting: Key Institutions and Actors - Roles...
Institutionalizing Performance Budgeting: Key Institutions and Actors - Roles...Institutionalizing Performance Budgeting: Key Institutions and Actors - Roles...
Institutionalizing Performance Budgeting: Key Institutions and Actors - Roles...
 
What is Joint Learning?
What is Joint Learning?What is Joint Learning?
What is Joint Learning?
 
NFM_master deck
NFM_master deckNFM_master deck
NFM_master deck
 
Cies 2015 global literacy & going to scale sc presentation 11march2015
Cies 2015 global literacy & going to scale sc presentation 11march2015Cies 2015 global literacy & going to scale sc presentation 11march2015
Cies 2015 global literacy & going to scale sc presentation 11march2015
 
Fostering research for policy and practitioners lessons and opportunities
Fostering research for policy and practitioners lessons and opportunitiesFostering research for policy and practitioners lessons and opportunities
Fostering research for policy and practitioners lessons and opportunities
 
NAP GN_Future of MEL
NAP GN_Future of MELNAP GN_Future of MEL
NAP GN_Future of MEL
 
Day 1 sat presentation re nfm feb 28
Day 1 sat presentation re nfm feb 28 Day 1 sat presentation re nfm feb 28
Day 1 sat presentation re nfm feb 28
 
Leadership for Affordable Housing Evaluation Study
Leadership for Affordable Housing Evaluation StudyLeadership for Affordable Housing Evaluation Study
Leadership for Affordable Housing Evaluation Study
 
Hefcereport gb
Hefcereport gbHefcereport gb
Hefcereport gb
 
Introducing Policy Implementation and Evaluation.
  Introducing Policy Implementation and Evaluation.  Introducing Policy Implementation and Evaluation.
Introducing Policy Implementation and Evaluation.
 
Affinity Symposium Presentation - CES
Affinity Symposium Presentation - CESAffinity Symposium Presentation - CES
Affinity Symposium Presentation - CES
 
Country dialog training external
Country dialog training externalCountry dialog training external
Country dialog training external
 
Country dialogue training external
Country dialogue training externalCountry dialogue training external
Country dialogue training external
 
Reevaluasi Metode Penentuan Prioritas Layanan Pemerintah
Reevaluasi Metode Penentuan Prioritas Layanan Pemerintah Reevaluasi Metode Penentuan Prioritas Layanan Pemerintah
Reevaluasi Metode Penentuan Prioritas Layanan Pemerintah
 
Transferring the purchasing role from international to national organizations...
Transferring the purchasing role from international to national organizations...Transferring the purchasing role from international to national organizations...
Transferring the purchasing role from international to national organizations...
 
May Pathfinder Listening and Learning event breakout session: Consortia auth...
May Pathfinder Listening and Learning  event breakout session: Consortia auth...May Pathfinder Listening and Learning  event breakout session: Consortia auth...
May Pathfinder Listening and Learning event breakout session: Consortia auth...
 

Plus de COP_HHA

Learning for UHC meeting
Learning for UHC meetingLearning for UHC meeting
Learning for UHC meetingCOP_HHA
 
Achat strategique - 30 september 2016
Achat strategique - 30 september 2016  Achat strategique - 30 september 2016
Achat strategique - 30 september 2016 COP_HHA
 
Système local information sanitaire capabilisant wp 2
Système local information sanitaire capabilisant wp  2Système local information sanitaire capabilisant wp  2
Système local information sanitaire capabilisant wp 2COP_HHA
 
Système local de santé wp1
Système local de santé wp1Système local de santé wp1
Système local de santé wp1COP_HHA
 
Session 12 Activités à venir de la CoP PSS : projet Mobilisation 2.0
Session 12 Activités à venir de la CoP PSS : projet Mobilisation 2.0Session 12 Activités à venir de la CoP PSS : projet Mobilisation 2.0
Session 12 Activités à venir de la CoP PSS : projet Mobilisation 2.0COP_HHA
 
Session 10 What have we learned so far ?
Session 10 What have we learned so far ? Session 10 What have we learned so far ?
Session 10 What have we learned so far ? COP_HHA
 
Session 9 Expérience de renforcement du système de santé au Bénin
Session 9 Expérience de renforcement du système de santé au BéninSession 9 Expérience de renforcement du système de santé au Bénin
Session 9 Expérience de renforcement du système de santé au BéninCOP_HHA
 
Session 8 Human Factors Predicting Failure and Success in Hospital Informatio...
Session 8 Human Factors Predicting Failure and Success in Hospital Informatio...Session 8 Human Factors Predicting Failure and Success in Hospital Informatio...
Session 8 Human Factors Predicting Failure and Success in Hospital Informatio...COP_HHA
 
Session 7 a Vérification communautaire et satisfaction des patients
Session 7 a Vérification communautaire et satisfaction des patientsSession 7 a Vérification communautaire et satisfaction des patients
Session 7 a Vérification communautaire et satisfaction des patientsCOP_HHA
 
Session 6 c Renforcer la participation communautaire à travers les médias soc...
Session 6 c Renforcer la participation communautaire à travers les médias soc...Session 6 c Renforcer la participation communautaire à travers les médias soc...
Session 6 c Renforcer la participation communautaire à travers les médias soc...COP_HHA
 
Session 6 b Les TIC pour faire entrer la santé au sein des foyers : l'exemple...
Session 6 b Les TIC pour faire entrer la santé au sein des foyers : l'exemple...Session 6 b Les TIC pour faire entrer la santé au sein des foyers : l'exemple...
Session 6 b Les TIC pour faire entrer la santé au sein des foyers : l'exemple...COP_HHA
 
Session 6 a DHIS2 : Overview and Implementation in West Africa
Session 6 a DHIS2 : Overview and Implementation in West AfricaSession 6 a DHIS2 : Overview and Implementation in West Africa
Session 6 a DHIS2 : Overview and Implementation in West AfricaCOP_HHA
 
Session 5 b Hospital Information Management with OpenClinic in Africa
Session 5 b Hospital Information Management with OpenClinic in AfricaSession 5 b Hospital Information Management with OpenClinic in Africa
Session 5 b Hospital Information Management with OpenClinic in AfricaCOP_HHA
 
Session 5 a Les NTIC au service de la relation Soignant-Soigné en 1° ligne, e...
Session 5 a Les NTIC au service de la relation Soignant-Soigné en 1° ligne, e...Session 5 a Les NTIC au service de la relation Soignant-Soigné en 1° ligne, e...
Session 5 a Les NTIC au service de la relation Soignant-Soigné en 1° ligne, e...COP_HHA
 
Session 5 Réforme du système d'information sanitaire en Côte d'Ivoire, quelle...
Session 5 Réforme du système d'information sanitaire en Côte d'Ivoire, quelle...Session 5 Réforme du système d'information sanitaire en Côte d'Ivoire, quelle...
Session 5 Réforme du système d'information sanitaire en Côte d'Ivoire, quelle...COP_HHA
 
Session 5 Implementation and USE OF central Health information systems suppo...
Session 5 Implementation and USE OF central  Health information systems suppo...Session 5 Implementation and USE OF central  Health information systems suppo...
Session 5 Implementation and USE OF central Health information systems suppo...COP_HHA
 
Session 4 c Cas du district de Ngoumou, Camaroun
Session 4 c Cas du district de Ngoumou, Camaroun Session 4 c Cas du district de Ngoumou, Camaroun
Session 4 c Cas du district de Ngoumou, Camaroun COP_HHA
 
Session 4 b Défi de réussite de solutions TIC dans les systèmes de santé
Session 4 b Défi de réussite de solutions TIC dans les systèmes de santéSession 4 b Défi de réussite de solutions TIC dans les systèmes de santé
Session 4 b Défi de réussite de solutions TIC dans les systèmes de santéCOP_HHA
 
Session 4 a Situation du CMA Congo II Douala, Cameroun
Session 4 a Situation du CMA Congo II Douala, Cameroun Session 4 a Situation du CMA Congo II Douala, Cameroun
Session 4 a Situation du CMA Congo II Douala, Cameroun COP_HHA
 

Plus de COP_HHA (19)

Learning for UHC meeting
Learning for UHC meetingLearning for UHC meeting
Learning for UHC meeting
 
Achat strategique - 30 september 2016
Achat strategique - 30 september 2016  Achat strategique - 30 september 2016
Achat strategique - 30 september 2016
 
Système local information sanitaire capabilisant wp 2
Système local information sanitaire capabilisant wp  2Système local information sanitaire capabilisant wp  2
Système local information sanitaire capabilisant wp 2
 
Système local de santé wp1
Système local de santé wp1Système local de santé wp1
Système local de santé wp1
 
Session 12 Activités à venir de la CoP PSS : projet Mobilisation 2.0
Session 12 Activités à venir de la CoP PSS : projet Mobilisation 2.0Session 12 Activités à venir de la CoP PSS : projet Mobilisation 2.0
Session 12 Activités à venir de la CoP PSS : projet Mobilisation 2.0
 
Session 10 What have we learned so far ?
Session 10 What have we learned so far ? Session 10 What have we learned so far ?
Session 10 What have we learned so far ?
 
Session 9 Expérience de renforcement du système de santé au Bénin
Session 9 Expérience de renforcement du système de santé au BéninSession 9 Expérience de renforcement du système de santé au Bénin
Session 9 Expérience de renforcement du système de santé au Bénin
 
Session 8 Human Factors Predicting Failure and Success in Hospital Informatio...
Session 8 Human Factors Predicting Failure and Success in Hospital Informatio...Session 8 Human Factors Predicting Failure and Success in Hospital Informatio...
Session 8 Human Factors Predicting Failure and Success in Hospital Informatio...
 
Session 7 a Vérification communautaire et satisfaction des patients
Session 7 a Vérification communautaire et satisfaction des patientsSession 7 a Vérification communautaire et satisfaction des patients
Session 7 a Vérification communautaire et satisfaction des patients
 
Session 6 c Renforcer la participation communautaire à travers les médias soc...
Session 6 c Renforcer la participation communautaire à travers les médias soc...Session 6 c Renforcer la participation communautaire à travers les médias soc...
Session 6 c Renforcer la participation communautaire à travers les médias soc...
 
Session 6 b Les TIC pour faire entrer la santé au sein des foyers : l'exemple...
Session 6 b Les TIC pour faire entrer la santé au sein des foyers : l'exemple...Session 6 b Les TIC pour faire entrer la santé au sein des foyers : l'exemple...
Session 6 b Les TIC pour faire entrer la santé au sein des foyers : l'exemple...
 
Session 6 a DHIS2 : Overview and Implementation in West Africa
Session 6 a DHIS2 : Overview and Implementation in West AfricaSession 6 a DHIS2 : Overview and Implementation in West Africa
Session 6 a DHIS2 : Overview and Implementation in West Africa
 
Session 5 b Hospital Information Management with OpenClinic in Africa
Session 5 b Hospital Information Management with OpenClinic in AfricaSession 5 b Hospital Information Management with OpenClinic in Africa
Session 5 b Hospital Information Management with OpenClinic in Africa
 
Session 5 a Les NTIC au service de la relation Soignant-Soigné en 1° ligne, e...
Session 5 a Les NTIC au service de la relation Soignant-Soigné en 1° ligne, e...Session 5 a Les NTIC au service de la relation Soignant-Soigné en 1° ligne, e...
Session 5 a Les NTIC au service de la relation Soignant-Soigné en 1° ligne, e...
 
Session 5 Réforme du système d'information sanitaire en Côte d'Ivoire, quelle...
Session 5 Réforme du système d'information sanitaire en Côte d'Ivoire, quelle...Session 5 Réforme du système d'information sanitaire en Côte d'Ivoire, quelle...
Session 5 Réforme du système d'information sanitaire en Côte d'Ivoire, quelle...
 
Session 5 Implementation and USE OF central Health information systems suppo...
Session 5 Implementation and USE OF central  Health information systems suppo...Session 5 Implementation and USE OF central  Health information systems suppo...
Session 5 Implementation and USE OF central Health information systems suppo...
 
Session 4 c Cas du district de Ngoumou, Camaroun
Session 4 c Cas du district de Ngoumou, Camaroun Session 4 c Cas du district de Ngoumou, Camaroun
Session 4 c Cas du district de Ngoumou, Camaroun
 
Session 4 b Défi de réussite de solutions TIC dans les systèmes de santé
Session 4 b Défi de réussite de solutions TIC dans les systèmes de santéSession 4 b Défi de réussite de solutions TIC dans les systèmes de santé
Session 4 b Défi de réussite de solutions TIC dans les systèmes de santé
 
Session 4 a Situation du CMA Congo II Douala, Cameroun
Session 4 a Situation du CMA Congo II Douala, Cameroun Session 4 a Situation du CMA Congo II Douala, Cameroun
Session 4 a Situation du CMA Congo II Douala, Cameroun
 

Dernier

Diseases of the Respiratory System (J00-J99),.pptx
Diseases of the Respiratory System (J00-J99),.pptxDiseases of the Respiratory System (J00-J99),.pptx
Diseases of the Respiratory System (J00-J99),.pptxEMADABATHINI PRABHU TEJA
 
Eating Disorders in Athletes I Sports Psychology
Eating Disorders in Athletes I Sports PsychologyEating Disorders in Athletes I Sports Psychology
Eating Disorders in Athletes I Sports Psychologyshantisphysio
 
Artificial Intelligence: Diabetes Management
Artificial Intelligence: Diabetes ManagementArtificial Intelligence: Diabetes Management
Artificial Intelligence: Diabetes ManagementIris Thiele Isip-Tan
 
Pharmacovigilance audits inspections.pptx
Pharmacovigilance audits inspections.pptxPharmacovigilance audits inspections.pptx
Pharmacovigilance audits inspections.pptxCliniminds India
 
Living Well Every Day: Lyons Wellness Practice | Nurtures Your Complete Health
Living Well Every Day: Lyons Wellness Practice | Nurtures Your Complete HealthLiving Well Every Day: Lyons Wellness Practice | Nurtures Your Complete Health
Living Well Every Day: Lyons Wellness Practice | Nurtures Your Complete HealthLyons Health
 
Anatomy Shelf Notevbhhhhhhhhhhhhhhhs.pdf
Anatomy Shelf Notevbhhhhhhhhhhhhhhhs.pdfAnatomy Shelf Notevbhhhhhhhhhhhhhhhs.pdf
Anatomy Shelf Notevbhhhhhhhhhhhhhhhs.pdfhezamzaki1
 
Three Keys to a Successful Margin: Charges, Costs, and Labor
Three Keys to a Successful Margin: Charges, Costs, and LaborThree Keys to a Successful Margin: Charges, Costs, and Labor
Three Keys to a Successful Margin: Charges, Costs, and LaborHealth Catalyst
 
person with disability and pwd act ppt.pptx
person with disability and pwd act ppt.pptxperson with disability and pwd act ppt.pptx
person with disability and pwd act ppt.pptxMUKESH PADMANABHAN
 
Health literacies in marginalised communities LILAC 24.pptx
Health literacies in marginalised communities LILAC 24.pptxHealth literacies in marginalised communities LILAC 24.pptx
Health literacies in marginalised communities LILAC 24.pptxPamela McKinney
 
2024 Compliatric Webianr Series - Contracts and MOUs from a HRSA Perspective.pdf
2024 Compliatric Webianr Series - Contracts and MOUs from a HRSA Perspective.pdf2024 Compliatric Webianr Series - Contracts and MOUs from a HRSA Perspective.pdf
2024 Compliatric Webianr Series - Contracts and MOUs from a HRSA Perspective.pdfCompliatric Where Compliance Happens
 
EYE CANCER.pptx prepared by Neha kewat digital learning
EYE CANCER.pptx prepared by  Neha kewat digital learningEYE CANCER.pptx prepared by  Neha kewat digital learning
EYE CANCER.pptx prepared by Neha kewat digital learningNehaKewat
 
Identifying Signs of Mental Health Presentation (1).pptx
Identifying Signs of Mental Health Presentation (1).pptxIdentifying Signs of Mental Health Presentation (1).pptx
Identifying Signs of Mental Health Presentation (1).pptxsandhulove46637
 
CECT NECK NECK ANGIOGRAPHY CAROTID ANGIOGRAPHY
CECT NECK NECK ANGIOGRAPHY CAROTID ANGIOGRAPHYCECT NECK NECK ANGIOGRAPHY CAROTID ANGIOGRAPHY
CECT NECK NECK ANGIOGRAPHY CAROTID ANGIOGRAPHYRMC
 
FINAL PROJECT IN EMPOWERMENT TECHNOLOGIES 11
FINAL PROJECT IN EMPOWERMENT TECHNOLOGIES  11FINAL PROJECT IN EMPOWERMENT TECHNOLOGIES  11
FINAL PROJECT IN EMPOWERMENT TECHNOLOGIES 11crzljavier
 
Empathy Is a Stress Response - Choose Compassion instead
Empathy Is a Stress Response - Choose Compassion insteadEmpathy Is a Stress Response - Choose Compassion instead
Empathy Is a Stress Response - Choose Compassion insteadAlex Clapson
 
LARYNGEAL CANCER.pptx Prepared by Neha Kewat
LARYNGEAL CANCER.pptx  Prepared by Neha KewatLARYNGEAL CANCER.pptx  Prepared by Neha Kewat
LARYNGEAL CANCER.pptx Prepared by Neha KewatNehaKewat
 
ACCA Version of AI & Healthcare: An Overview for the Curious
ACCA Version of AI & Healthcare: An Overview for the CuriousACCA Version of AI & Healthcare: An Overview for the Curious
ACCA Version of AI & Healthcare: An Overview for the CuriousKR_Barker
 
"ANATOMY AND PHYSIOLOGY OF THE SKIN".pdf
"ANATOMY AND PHYSIOLOGY OF THE SKIN".pdf"ANATOMY AND PHYSIOLOGY OF THE SKIN".pdf
"ANATOMY AND PHYSIOLOGY OF THE SKIN".pdfDolisha Warbi
 

Dernier (20)

Diseases of the Respiratory System (J00-J99),.pptx
Diseases of the Respiratory System (J00-J99),.pptxDiseases of the Respiratory System (J00-J99),.pptx
Diseases of the Respiratory System (J00-J99),.pptx
 
Eating Disorders in Athletes I Sports Psychology
Eating Disorders in Athletes I Sports PsychologyEating Disorders in Athletes I Sports Psychology
Eating Disorders in Athletes I Sports Psychology
 
Artificial Intelligence: Diabetes Management
Artificial Intelligence: Diabetes ManagementArtificial Intelligence: Diabetes Management
Artificial Intelligence: Diabetes Management
 
Annual Training
Annual TrainingAnnual Training
Annual Training
 
Pharmacovigilance audits inspections.pptx
Pharmacovigilance audits inspections.pptxPharmacovigilance audits inspections.pptx
Pharmacovigilance audits inspections.pptx
 
Living Well Every Day: Lyons Wellness Practice | Nurtures Your Complete Health
Living Well Every Day: Lyons Wellness Practice | Nurtures Your Complete HealthLiving Well Every Day: Lyons Wellness Practice | Nurtures Your Complete Health
Living Well Every Day: Lyons Wellness Practice | Nurtures Your Complete Health
 
Anatomy Shelf Notevbhhhhhhhhhhhhhhhs.pdf
Anatomy Shelf Notevbhhhhhhhhhhhhhhhs.pdfAnatomy Shelf Notevbhhhhhhhhhhhhhhhs.pdf
Anatomy Shelf Notevbhhhhhhhhhhhhhhhs.pdf
 
SCOPE OF CRITICAL CARE ORGANIZATION
SCOPE OF CRITICAL CARE ORGANIZATIONSCOPE OF CRITICAL CARE ORGANIZATION
SCOPE OF CRITICAL CARE ORGANIZATION
 
Three Keys to a Successful Margin: Charges, Costs, and Labor
Three Keys to a Successful Margin: Charges, Costs, and LaborThree Keys to a Successful Margin: Charges, Costs, and Labor
Three Keys to a Successful Margin: Charges, Costs, and Labor
 
person with disability and pwd act ppt.pptx
person with disability and pwd act ppt.pptxperson with disability and pwd act ppt.pptx
person with disability and pwd act ppt.pptx
 
Health literacies in marginalised communities LILAC 24.pptx
Health literacies in marginalised communities LILAC 24.pptxHealth literacies in marginalised communities LILAC 24.pptx
Health literacies in marginalised communities LILAC 24.pptx
 
2024 Compliatric Webianr Series - Contracts and MOUs from a HRSA Perspective.pdf
2024 Compliatric Webianr Series - Contracts and MOUs from a HRSA Perspective.pdf2024 Compliatric Webianr Series - Contracts and MOUs from a HRSA Perspective.pdf
2024 Compliatric Webianr Series - Contracts and MOUs from a HRSA Perspective.pdf
 
EYE CANCER.pptx prepared by Neha kewat digital learning
EYE CANCER.pptx prepared by  Neha kewat digital learningEYE CANCER.pptx prepared by  Neha kewat digital learning
EYE CANCER.pptx prepared by Neha kewat digital learning
 
Identifying Signs of Mental Health Presentation (1).pptx
Identifying Signs of Mental Health Presentation (1).pptxIdentifying Signs of Mental Health Presentation (1).pptx
Identifying Signs of Mental Health Presentation (1).pptx
 
CECT NECK NECK ANGIOGRAPHY CAROTID ANGIOGRAPHY
CECT NECK NECK ANGIOGRAPHY CAROTID ANGIOGRAPHYCECT NECK NECK ANGIOGRAPHY CAROTID ANGIOGRAPHY
CECT NECK NECK ANGIOGRAPHY CAROTID ANGIOGRAPHY
 
FINAL PROJECT IN EMPOWERMENT TECHNOLOGIES 11
FINAL PROJECT IN EMPOWERMENT TECHNOLOGIES  11FINAL PROJECT IN EMPOWERMENT TECHNOLOGIES  11
FINAL PROJECT IN EMPOWERMENT TECHNOLOGIES 11
 
Empathy Is a Stress Response - Choose Compassion instead
Empathy Is a Stress Response - Choose Compassion insteadEmpathy Is a Stress Response - Choose Compassion instead
Empathy Is a Stress Response - Choose Compassion instead
 
LARYNGEAL CANCER.pptx Prepared by Neha Kewat
LARYNGEAL CANCER.pptx  Prepared by Neha KewatLARYNGEAL CANCER.pptx  Prepared by Neha Kewat
LARYNGEAL CANCER.pptx Prepared by Neha Kewat
 
ACCA Version of AI & Healthcare: An Overview for the Curious
ACCA Version of AI & Healthcare: An Overview for the CuriousACCA Version of AI & Healthcare: An Overview for the Curious
ACCA Version of AI & Healthcare: An Overview for the Curious
 
"ANATOMY AND PHYSIOLOGY OF THE SKIN".pdf
"ANATOMY AND PHYSIOLOGY OF THE SKIN".pdf"ANATOMY AND PHYSIOLOGY OF THE SKIN".pdf
"ANATOMY AND PHYSIOLOGY OF THE SKIN".pdf
 

Taking RBF From Scheme to System

  • 1. Taking Results Based Financing from Scheme to System: a multi-country study Zubin Shroff & Bruno Meessen CoP Webinar January 20th 2017
  • 2. asd Presentation Outline Part 1: • Our research • Scaling up is multidimensional • Scaling up is a four phase process Part 2: • Moving from one phase to the next: context, actors, policy content and processes • Larger lessons learnt from the cross-country research
  • 3. asd Main question: what are the enablers and barriers for the scale-up of RBF schemes? Armenia Cameroon Macedonia Tanzania Burundi Chad Mozambique Uganda Cambodia Kenya Rwanda
  • 4. • Mainly qualitative methods • Iterative Documentary review Timeline development Key informant interviews Source: Sieleunou et al. 2015
  • 5. asd Idea #1: Scale-up occurs over 5 dimensions Dimension Content Population Coverage Geographical coverage, age and income groups covered, total people covered Service Coverage Number, types, level, affiliation of services Health System Integration & Institutionalization Connections with the six building blocks of the health system Cross-sectoral diffusion Changes outside the health sector Knowledge & Ideas Status of the knowledge
  • 6. asd An illustration (1) 0 1 2 3 4 5 Population Coverage Service Coverage IntegrationCross sector diffusion Knowledge
  • 8. asd Generation (from idea to project) Adoption (from project to program) Institutionalisation (from program to policy) Expansion (from policy to system) Idea #2: the four phase model of scale-up • Reason: scaling up require some key resoures/currencies and these resources are themselves partly an outcome of the process. • This is an emerging pattern, not a law.
  • 9. asd Phase 1: Generation • Movement from initial idea to one or more pilots • End point: pilot implemented as proof of concept Generation (from idea to project) Adoption (from project to program) Institutionalisation (from program to policy) Expansion (from policy to system)
  • 10. asd Phase 2: Adoption • Movement from pilot project to a national ‘program’: a coherent and identifiable set of institutional arrangements organising the transfer of resources to service providers is in place (contracts, guidelines…) • Increased coverage in terms of administrative units implementing and hence people covered → a heavy operational stage • End point: a national unit, trainers & digital tools are in place to roll out (knowledge!) Generation (from idea to project) Adoption (from project to program) Institutionalisation (from program to policy) Expansion (from policy to system)
  • 11. asd Phase 3: Institutionalisation • This refers to the transition from a program to a national policy • Integration within the six ‘building blocks’. • Governance: A stated objective of national strategic documents and decrees • Finance: public funding and harmony with other financing mechanisms. • End point: PBF is an integrated provider payment mechanism for whole country Generation (from idea to project) Adoption (from project to program) Institutionalisation (from program to policy) Expansion (from policy to system)
  • 12. Phase 4: Expansion • This refers to the transition from a mechanism to a set of key principles informing the design and implementation of public policy in the health sector but, also beyond. • Paying for results and provider autonomy inform fields like education Generation (from idea to project) Adoption (from project to program) Institutionalisation (from program to policy) Expansion (from policy to system)
  • 15. asd Sample: countries at different stages…
  • 16. Moving Across Phases- Phase 1: Generation • Contextual factors- – Interaction of global (aid effectiveness), regional (influence of Rwanda) and national context (RBF as a solution to address a met need) – Previous experience with organizational and financing reforms of the health systems- voucher schemes, direct cash transfers • Actors – Seminal Role of Knowledge brokers or Health Financing Experts, along with international agencies (bilaterals, multilaterals, faith based) in sowing the seed • Content – Broad agreement on general principles and practices among community of knowledge brokers – Funding agencies had some role in determining focus, over time govts played increasingly important role
  • 17. Moving Across Phases- Phase 2: Adoption • Contextual factors- – National context relatively more important; pre-existing autonomous institutions; enabling legal frameworks and changes – National agenda of transparency and results hastens process • Actors – International agencies continue to be important (funding and technical assistance); though usually one agency takes dominant role (Rwanda, Cameroon, Kenya, Armenia) – Role for national policy entrepreneurs, from MOH or pilot programs – Development of critical mass of national level practitioners • Process – Coordination and alignment of stakeholders, task force
  • 18. Moving Across Phases- Phase 3: Institutionalization • High Level of continuity between this and previous stage, still needs active management • Contextual factors- – Legal frameworks continue to evolve – Enabled by increased security of funding, especially from domestic sources • Actors – Increasing political and technical leadership of MOH and national RBF experts – National ownership goes beyond the MOH, the ‘coalition of change’- MOF, local govts, social security agency • Content – Greater country level influence on design, reflecting increased domestic resources and technical leadership (Cambodia-internal contracting, Rwanda-cPBF)
  • 19. Moving Across Phases- Phase 4: Expansion • Contextual factors- – Knowledge on integration in health informs attempts to extend PBF principles to other sectors • Actors – National level expertise and high level political support to take forward PBF principles • Content – Variations develop in extending PBF principles to other sectors including local government administration
  • 21. Five broad lessons • Lesson 1: Some countries stay stuck in phase 1 • Lesson 2: Rhetoric and framing matter • Lesson 3: Scale up requires a chain of actors • Lesson 4: Look beyond the label for content when examining interactions • Lesson 5: Balance technically best against politically feasible
  • 22. Lesson 1: Why some countries get stuck in Phase 1 • A pilot is not a pilot. Successful pilot doesn’t ensure scale up – How it is framed- disease focused or health systems strengthening (Mozambique vs Cameroon) – Who implements it- entity a) largely focused on a single disease, b) with political, technical, financial influence at country level – Which level of government is engaged ? Engagement at the district or provincial level initial rapid uptake, but to national level may then be more challenging (Mozambique, Uganda) – Where it is housed in national government apparatus – Is it implemented largely outside the public system? – More pilots are not always better → Forthcoming webinar: Kiendrébéogo et al 2017
  • 23. Lesson 2: Rhetoric and Framing Matter • RBF programs have been put forth as transparency enhancing and part of a results agenda • This works in some settings (Cameroon and Rwanda), but may not be universally the case; potential to directly confront interests keen on status quo • Needs analysing political situation to see if this is most appropriate strategy and otherwise looking for individuals and groups at national level who can help place transparency and results on the agenda, in other words-create the window of opportunity
  • 24. Lesson 3: Scale up needs a chain of actors • Seen how dominant actors varied by stage – each control a key resource for the specific stage • Invest in building your support coalition – anticipate and involve at an early stage • As stakeholders change, so do their incentives. Incentives for provincial level governments to adopt PBF pilots may be completely different from national governments • Adapt your framing - initial PBF pilot framed as solving an urgent need, issues of sustainability may not be immediately important, but as you progress this becomes more important
  • 25. Lesson 4: Look beyond the label and at the content of other reforms • Decentralization and increased autonomy, while enabling to PBF programs in a number of ways, also alter who decides what, something that changes incentives for different players • Devolution in Kenya- increased accountability buy taking decision-making closer to people, but increased chance of reduced spending on public goods and more on visible things like infrastructure
  • 26. Lesson 5: Balance the technically best program against what is politically feasible • A technically sub-optimal intervention may be the right choice when weighed against increased government buy in and therefore likelihood of long term sustainability • Cambodia example of choice of program, government wanted greater control and chose model of contracting enabling this

Notes de l'éditeur

  1. Stage 1 – bring your scheme into reality Movement from initial idea to one or more pilots End point-pilot implemented as proof of concept Stage 2 – bring your scheme into management tools Movement from pilot project to a ‘program’- coherent and identifiable set of institutional arrangements organising the transfer of resources to service providers Increased coverage in terms of administrative units implementing and hence people covered Typically guidelines are in place to develop and implement contracts and instruments required to administer the programme Stage 3 – bring your scheme into systems This refers to the transition from a program to a national policy RBF like approaches become an integral part of national health financing policies and are inscribed in and are a stated objective of national strategic documents and decrees Public finance management procedures reflect changes enabling PBF implementation and integration with areas like management information systems are usually addressed End point- PBF or PBF like arrangements are part of provider payment mechanisms for whole country Stage 4 – bring your scheme into society This refers to the transition of RBF from a provider payment mechanism for health to a key principle informing the design and implementation of public policy in areas and sectors beyond health Paying for results and provider autonomy inform fields like education
  2. Stage 1 – bring your scheme into reality Movement from initial idea to one or more pilots End point-pilot implemented as proof of concept Stage 2 – bring your scheme into management tools Movement from pilot project to a ‘program’- coherent and identifiable set of institutional arrangements organising the transfer of resources to service providers Increased coverage in terms of administrative units implementing and hence people covered Typically guidelines are in place to develop and implement contracts and instruments required to administer the programme Stage 3 – bring your scheme into systems This refers to the transition from a program to a national policy RBF like approaches become an integral part of national health financing policies and are inscribed in and are a stated objective of national strategic documents and decrees Public finance management procedures reflect changes enabling PBF implementation and integration with areas like management information systems are usually addressed End point- PBF or PBF like arrangements are part of provider payment mechanisms for whole country Stage 4 – bring your scheme into society This refers to the transition of RBF from a provider payment mechanism for health to a key principle informing the design and implementation of public policy in areas and sectors beyond health Paying for results and provider autonomy inform fields like education