Annual Results and Impact Evaluation Workshop for RBF - Day Five - New Technologies for Results-Based Financing

New technologies for Result Based Financing Impact Evaluation Workshop, Argentina, March 2014

1. Introduction

RBF contributes to more efficiency and better governance

Efficiency : •  Allocative efficiency: Funding is targeted on cost-effective

interventions •  Technical efficiency: strong incentive for greater effort, better

management, innovation. •  Transactional efficiency: Direct transfer to providers, low

transaction costs.

But also improves transparency and accountability: •  Clear split of functions •  Stress on verification and fraud control •  Patient’s feedback and social accountability •  Transparency and benchmarking

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Outline how technologies are currently used in RBF systems.

Explore how new technologies can further enhance good governance

and efficiency.

Objective of the session 4

1.  Five years of mHealth programs: what can we learn from a RBF

perspective?

2.  New technologies for supply-side RBF

3.  Mobile technologies for demand side financing

4.  Questions and answers

Outline 5

2. Learning from mHealth programs for RBF

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3. Supply side RBF: New technologies for good governance and enhanced efficiency

Countries using web-based technologies •  Nigeria : www.nphcda.thenewtechs.com •  Benin : www.beninfbr.org •  Cameroun : www.fbrcameroun.org •  Burundi : www.fbpsanteburundi.bi •  Senegal : www.fbr.sante.gouv.sn •  Zambia : www.rbfzambia.gov.zm •  Chad : www.fbrtchad.org •  DRC : http://cd.thenewtechs.com/ •  Rwanda : http://www.pbf.moh.gov.rw/ •  Laos •  Lesotho •  Zimbambwe •  ROC •  Tadjikistan

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Examples: 10

Examples: 11

Example of Benin: 12

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RBF web-applications are important

RBF management

Better heath System Management

Accountability and transparency

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A. Transparency, accountability and good governance

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Case of Benin

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Enhanced accountability through active sharing of RBF data

WEB & social networks Email Mobile Phone

•  General public •  Managers •  Health authorities •  Donors •  Local authorities

•  Health staff •  Community health workers •  Patients

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B. Verification and social accountability

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How can mobile technology be used for verification and client satisfaction?

3 options : SMS, call center, interactive voice recognition systems (IVR)

Pro and cons based on TTC’s Uganda experience.

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SMS

•  Verification of service uptake by patients via SMS

•  Patients also feedback their satisfaction/experiences

a. Targeted SMS for verification b. Catch all SMS for satisfaction:

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Patients’ feedback 22

C. Data collection via mobiles: quality evaluation & IE surveys

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Mobile/tablets for data collection

Most countries collect information about quality of care on paper forms. •  Only a limited number of data elements on

quality are computerized. •  Some of the data elements that are not

collected are of high value for the health system stewardship.

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Tablet based data entry has three advantages: •  Improve the quality of data collection •  Can add media (pictures, video) to the survey

form •  Immediate feedback

4. New Technologies for Demand Side RBF

1.  Brief overview of DSF

2.  Synergies in DSF and SSF

3.  Key characteristics of DSF approaches

4.  Case study: eVouchers in Ethiopia

5.  Case study: Mobile Money for DSF (and SSF)

Outline of the session 26

SSF and DSF Govt/ donor funding

Contracting Agency (Govt/ Non-Govt)

Health facili4es/ health

managers

Results data

$ Performance-‐based

financing and contrac4ng

Govt/ donor funding

Contracting Agency (Govt/ Non-Govt)

Health facili4es/ health

managers

Results data

$

HEF cards/ Insurance cards/

Vouchers

Clients

Services

En4tlement (cards/ vouchers)

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1. Brief overview of DSF

Conditional Cash Transfers (CCT) Vouchers Health Insurance

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2. Synergies in DSF and SSF

Results-based Financing Examples

Incentives

Provider Client

Supply-side Performance based contracting X

Demand-side

Conditional cash transfers X

Health insurance X X

Vouchers X X

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3. Key characteristic of DSF Characteristics CCT Vouchers SHI SSF

Enrolment of beneficiaries Yes Yes (with voucher

distribution) Yes (usually with co-payment)

No

Contracting of providers No Yes Yes Yes

Quality Assurance No Yes Yes Yes

Distribution of incentives Yes (cash) Yes (voucher) Yes (insurance card) To providers

Payments To beneficiaries To providers To providers as premiums To providers

Claims processing No Yes Yes Yes

Fraud control Yes Yes Yes Yes

Verification Yes Yes Yes Yes

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4. Case study: eVouchers in Ethiopia

•  MSI Ethiopia started in 2012 a voucher programme for FP (IUD);

•  Targeted towards poor and marginalised young people (15-29 years);

•  Piloted eVouchers for 18 weeks in 5 towns (2,521 eVouchers issued);

•  Aim is to make it easier for targeted group to redeem the voucher, reduce management cost, simplify monitoring;

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Problems with paper vouchers:

•  Can easily be damaged or lost;

•  High implementation costs;

•  Can take weeks to print and dispatch;

•  Require multi-stage monitoring process.

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4. Case study: eVouchers in Ethiopia: Results

46%

•  Many were poor •  Increased administrative efficiency.

redemption rate (8,278/18,095 vouchers)

92% were 15-29 years old

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Challenges, limitations and lessons learned:

•  No direct attribution to eVouchers;

•  Providers not sending confirmation SMS led to delays

•  Only 24% of target group had a phone.

24%

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5. Case study: Mobile Money for DSF (and SSF)

What is it and how does it work?

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5. Case Study: Mobile Money for DSF (and SSF)

Why mobile money (MM)?

•  Very limited access to banks and twice as many MM kiosks in early 2011;

•  Transport cost, risk of fraud and security risks linked to cash payments;

Marie Stopes Madagascar FP voucher programme

MM kiosk

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Results:

•  29% of vouchers distributed reimbursed via MM;

•  35% of claims reimbursed within 48hours;

•  Increased financial and administrative efficiency;

•  Social franchisees find it easy to use.


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Challenges, limitations and lessons learned:

•  Need to work with all phone operators of the country (and have interoperability);

•  Need to assess access to MM and compare MM providers; •  Need to strike a balance between fraud control and timely payments; •  MM payment systems should be linked to a database to simplify monitoring; •  Automated payments limit risk of fraud and data entry errors; •  SMS claims should be short and easy to type and sent via a toll-free number.


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5. Case Study: Mobile Money for DSF (and SSF) Some considerations for mobile money:

Liquidity (Mozambique) Phone ownership (Pakistan) Policy (Bihar, India)

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Take away messages

Vote for the two most important take away messages! 1.  Technology will play a key role in future RBF

systems 2.  Technology can help reach the poorest and

improve coverage 3.  Technology is essential for transparency and

good governance 4.  Technology can improve efficiency and

reduce implementation cost of RBF 5.  New technology is attractive but beware of

the hype: do not underestimate the cost, complexity and burden!

6.  Argentinian wine is excellent!

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Thank you!

•  Discussion paper :

•  Interviews on mHealth and mobile technology for social accountability

•  Powerpoint presentations in FR and Eng :

•  Live audience participation software : polleveywhere.com

Healthcare

Annual Results and Impact Evaluation Workshop for RBF - Day Five - New Technologies for Results-Based Financing