We just got back from Nepal to see how results-based financing has, or hasn’t, changed the way their education system functions. Over lunch, we asked our counterparts at the Ministry of Education: “What’s been different since the introduction of results-based financing?” Their response: “Oh, we just pay more attention to the indicators.” While this may sound peripheral, it speaks to the power of RBF.
A blogpost on financial incentives in health by one of us in September 2015 generated considerable interest. The post raised several issues, one being whether demand-side financial incentives (like maternal vouchers) are more or less effective at increasing the uptake of key maternal and child health (MCH) interventions than supply-side financial incentives (variously called pay-for-performance (P4P) or performance-based financing (PBF)).
The four of us are now hard at work investigating this question — and related ones — in a much more systematic fashion. And we'd very much welcome your help.
I just returned from Paris where I had the pleasure of participating in a defining moment for the global education community: the adoption of the Education 2030 Framework for Action.
This Framework will guide countries through the implementation of the new Sustainable Development Goal 4 (adopted at the United Nations in September), which says that all girls and boys should complete free, equitable and quality primary and secondary education by 2030.
These days, Results-Based Financing (RBF) is a sexy term in the development world, with more and more projects focused on linking financing to pre-determined results. Just this past May, World Bank President Jim Kim committed to double results-based financing for education to US$5 billion over the next five years.
The Results in Education for All Children (REACH) trust fund aims to boost global knowledge in RBF, through research and operations. Supported by Norway, Germany, and USAID, it finances Knowledge, Learning, and Innovation (KLI) grants and country program grants.
After years of bad news from developing countries about high rates of health worker absenteeism, and low rates of delivery of key health interventions, along came what seemed like a magic bullet: financial incentives. Rather than paying providers whether or not they show up to work, and whether or not they deliver key interventions, doesn’t it make sense to pay them—at least in part—according to what they do? And if, after doing their cost-benefit calculations, women decide not to have their baby delivered in a health facility, not to get antenatal care, and not take their child to be immunized, then doesn’t it make sense to try to change the benefit-cost ratio by paying them to do so?
A couple of months ago, I visited Chandra Shekhar Azad College in Sehore, about an hour’s drive from Bhopal, the capital of the state of Madhya Pradesh, India. It was a short visit, but long enough to see that college students the world over have similar dreams and see higher education as a way to realize them.
Yet, 121 million children today remain out of school. These young people are the hardest to reach—due to poverty, gender barriers, remoteness, and disability. We must make a new concerted push to bring all children into the classroom.
In addition to this challenge of improving attendance and access, we face an even tougher problem ahead: ensuring that children are learning while they’re in school. The sad truth is that most education systems are not serving the poorest children well. This is a tragic failure of our educational aspirations for the world’s youth.
Subsidized health insurance is unlikely to lead to Universal Health Coverage (UHC); insurance coverage doesn’t always improve financial protection and when it does, doesn’t necessarily eliminate financial protection concerns; and tackling provider incentives may be just as – if not more – important in the UHC agenda as demand-side initiatives. These are the three big and somewhat counterintuitive conclusions of the Health Equity and Financial Protection in Asia (HEFPA) research project that I jointly coordinated with Eddy van Doorslaer and Owen O’Donnell.
As we all now know, UHC is all about ensuring that everyone – irrespective of their ability to pay – can access the health services they need without suffering undue financial hardship in the process. The HEFPA project set out to explore the effectiveness of a number of UHC strategies in a region of the world that has seen a lot of UHC initiatives: East Asia. The project pooled the skills of researchers from six Asian countries (Cambodia, China, Indonesia, the Philippines, Thailand and Vietnam), several European universities and the World Bank.
Although Results-Based Financing (RBF), an approach that allocates public funds based on the achievement of specified results, has had some practical successes in the health and education sectors, its use in the sanitation sector has been limited. Identifying the Potential for Results-Based Financing for Sanitation by Sophie Trémolet looks at the potential for application.
I spent a great couple of days earlier this week with representatives of civil society organizations (CSOs) from around the world who are members of our World Bank – Civil Society Consultative Group on Health, Nutrition, and Population. When it was launched earlier this year, we envisioned the consultative group as a forum for CSOs and our Bank-wide health team to share perspectives and discuss frankly any concerns we may have about our respective work in health, nutrition, and population, and to learn from one another. So it’s exciting to see this group beginning to move from theory to action.