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 region

Supports the efforts of the governments of the region to achieve the health Millennium Development Goals

A portion of grant funding is conditional on achieving health results focused on the poorest.

SM2015 INITIATIVE

Belize

Costa Rica

El Salvador

Guatemala

Honduras

Nicaragua

Panamá

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 services

Social, 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”