Salud Mesoamérica 2015Initiative
Rena Eichler, PhD
Broad Branch Associates
The Initiative is a five year public-private partnership between the Bill & Melinda Gates Foundation, the Carlos Slim Health Institute, the Government of Spain, the IDB and the governments of 8 countries in the Mesoamerican regionSupports the efforts of the governments
of the region to achieve the health Millennium Development GoalsA portion of grant funding is conditional
on achieving health results focused on the poorest.
SM2015 INITIATIVE
BelizeCosta RicaEl SalvadorGuatemalaHondurasNicaraguaPanamá Chiapas, Mexico
ELIGIBLE COUNTRIES
Total contribution: US$142million
Bill & Melinda Gates FoundationCarlos Slim Health InstituteGovernment of Spain- AECID
All donors contributing equally to all scheduled activities
SM2015 BUDGET
JUSTIFICATION
In the Mesoamerican region there are deep and large gaps between the health and welfare of the population of lower income and highest income quintiles.
WHY MESOAMERICA?
Lowest
Highes
t
Source: Tristao. I. Perfiles de los países Mesoamericanos. IDB Working paper 2010
The poorest 20% access fewer services of proven effectiveness and quality is inadequate. Reasons:
Public spending is low and inequitable. Health policy is not necessarily guided by evidence.Limited accountability for results at all levels.Weak/dysfunctional incentive s to increase the coverage and quality of health servicesSocial, financial and geographic access barriers
In addition: Not enough regional cooperation in the control/elimination of malaria and dengue.
MAIN PROBLEMS
OBJECTIVES AND STRATEGIES
1. Increase supply, quality and utilization of basic health services in the target population
2. Create a strong policy and financial commitment to close the equity gap in health
3. Contribute to awareness about the implementation of large-scale interventions of proven efficacy among the poorest
SPECIFIC OBJECTIVES
GOAL:Reduce maternal and infant mortality in women
and children under 5 years of the 20% poorest
SM2015 IMPACT AND PROCESS THEORY
Increased demand for interventions among poor
Increased availability and use of evidence for shaping pro-poor policy and practice
Increased allocation of health resources to the poorest populations
Increased supply of quality services among poor
Reduction in neonatal, child, and maternal mortality in
target population
Increase in effective coverage, at scale, of key interventions
New incentives in aid relationship via PBA model
HOW DOES SM2015 WORK?
STRUCTURE
Inter-American Development
Bank• General
Administrator
Coordination Unit based in
Panama• SM2015
dedicated coordination unit staffed by the IDB
Governments
• Implementing and co-financing partner
RESULT BASED FINANCING
Agreement between the IDB and the governments
Results-based disbursement
Using predetermined performance indicators and independent measurement of achievements
TICN
RESULT BASED FINANCING
IT+PT
Total Operation Cost: Investment tranche(IT) + Counterpart (CN)
Assignment SM2015: Investment Tranche (IT) + Performance Tranche(PT)
Performance Matrix to 5 yearsIf countries meet the targets set, they receive the
performance award and proceed to prepare a second operation.
If countries don’t perform, they receive technical assistance and a second chance
Operation 1 Operation 2
Operation 3
PERFORMANCE MATRIX
PERFORMANCE EVALUATION
• Country is reimbursed 50% of its contribution
• Free to use within the health sector
• Country proceeds to the higher targets set for the following 12-18 months
If goals are met
• Country is provided with technical assistance • Same goals maintained for next
operation• 2 strike policy
If goals are not
met
Household and facility surveys to establish baselines, targets and attained results.Completely external verificationRigorous impact evaluations planned in
some countries.Process documentation and qualitative
research to complement quantitative assessments.Countries report to a performance
dashboard publicly available on line.
MEASUREMENT, VERIFICATION AND LEARNING
REFLECTIONS
Hands off approach if countries achieve results.Technical assistance mandated if results
are weak.Pro- poor focusRequiring that governments co-finance
the initiative may contribute to sustainabilityCountry level incentives may catalyze
broad system changes needed to achieve results
A NEW WAY TO PROVIDE AID?
Will performance rewards to national governments cascade down to affect the actions of service providers and households?Is relying on completely external
verification a missed opportunity to strengthen country generation and use of health information for decisions?Are 18 month performance periods long
enough to see significant improvements in results?
TO PONDER
www.saludmesoamerica2015.org
VISITE OUR WEB
“An innovative public/private partnership
to reduce health equity gaps in Mesoamerica”