Implementation Research Taking Results-Based Financing from Scheme to System

1. Implementation ResearchTaking Results-Based Financing from Scheme to System Maryam Bigdeli Third Global Symposium on Health Systems Research Satellite meeting – 30 September 2014 Bridging the worlds of research and policy

2. Call for Expressions of Interest • Support the development of analytical case studies on RBF and similar initiatives in selected LMICs • Answer questions on enablers and hindrances in the transition of these types of initiatives from a scheme/project to being fully integrated into the health system • A multi-country study aimed at drawing cross-cutting lessons on enablers and challenges to scaling-up RBF • Support from a technical coordinating centre : Bruno Meessen and team at Institute of Tropical Medicine in Antwerp • Protocol development workshop in October 2014

3. Our working definitions Results-Based Financing Purchasing mechanism that links payments (to producers or consumers) to process or output measures (which may be quantitative or quality measures or a mix of both) that can serve as indicators of, or proxies for, improved health outcomes Implementation Research The scientific study of the effective delivery of health interventions in diverse settings and within the existing range of health systems. Implementation research goes beyond understanding what is and is not working, to explain also how and why implementation is going right or wrong in that particular setting Program scale-up: Coverage: geographical, population coverage, services System integration: institutional arrangements for purchasing function, relationships with health system reforms or financial management reforms etc. Sustainability: ownership, sustainability and institutionalization of verification mechanisms, whether RBF has been made a part of national policy

4. Research questions Overarching question: What are the dynamics (actors and factors) that enable or hinder RBF scale-up decisions and/or implementation? Sub-questions: • What was the motivation behind the decision to scale up? Who were the drivers, actors and what were the processes followed? • To what extent is the scale up of the RBF program being achieved? What are the factors explaining this? What are the key health system and wider government reforms that should be considered? • Which strategies and processes have been effective in sustaining the scale up and integration of RBF? • What were the expected, unexpected, positive, and negative consequences of RBF on and beyond the health system, including for example fiscal and governance implications that had to be taken into account during scaling-up?

5. Selected proposals

6. Rationale for selecting • Quality of proposals and skills of applicants–reviewed by ITM, AHPSR, WHO HSF, WB • Scale up achieved vs about to start / in the pipeline • Pilot failed to scale up • Multiple pilots / experiences • Structural challenges to scale (e.g. devolution process or poor governance • European perspective on pay for performance experience

7. Next steps • Adopt a common view • Different stages of scaling-up (Meessen et al) • Different approach for each stage -> Brainstorming and protocol workshop 20-24 October 2014 in Antwerp • Field data collection and analysis – 12 months • Final workshop • Cross-cutting lessons • Common outputs and publications

8. Questions to Maryam Bigdeli bigdelim@who.int Bruno Meessenbmeessen@itg.be Thank you!