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Salud Mesoamérica 20 15 Initiative Rena Eichler , PhD Broad Branch Associates

Salud Mesoamérica 20 15 Initiative Rena Eichler , PhD Broad Branch Associates. SM2015 INITIATIVE.

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Salud Mesoamérica 20 15 Initiative Rena Eichler , PhD Broad Branch Associates

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  1. SaludMesoamérica2015Initiative Rena Eichler, PhD Broad Branch Associates

  2. SM2015 INITIATIVE • 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.

  3. Eligible countries • Belize • Costa Rica • El Salvador • Guatemala • Honduras • Nicaragua • Panamá • Chiapas, Mexico

  4. SM2015 BUDGET Total contribution: US$142million • Bill & Melinda Gates Foundation • Carlos Slim Health Institute • Government of Spain- AECID All donors contributing equally to all scheduled activities

  5. Justification

  6. WHY Mesoamerica? • 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. • Lowest • Highest Source: Tristao. I. Perfiles de los países Mesoamericanos. IDB Working paper 2010

  7. MAIN problems 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.

  8. OBJECTIVES AND STRATEGIES

  9. GOAL: Reduce maternal and infant mortality in women and children under 5 years of the 20% poorest Specific objectives • Increase supply, quality and utilization of basic health services in the target population • Create a strong policy and financial commitment to close the equity gap in health • Contribute to awareness about the implementation of large-scale interventions of proven efficacy among the poorest

  10. SM2015 impact and process theory Increased availability and use of evidence for shaping pro-poor policy and practice Increased demandfor interventions among poor Increase in effective coverage, at scale, of key interventions Reduction in neonatal, child, and maternal mortality in target population Increased supplyof quality services among poor Increased allocation of health resources to the poorest populations New incentives in aid relationship via PBA model

  11. How DOES SM2015 work?

  12. structure

  13. Result based financing • Agreement between the IDB and the governments • Results-based disbursement • Using predetermined performance indicators and independent measurement of achievements

  14. Result based financing Total Operation Cost: Investment tranche(IT) + Counterpart (CN) Assignment SM2015: Investment Tranche (IT) + Performance Tranche (PT)

  15. Performance matrix

  16. Performance Evaluation If goals are not met • Country is provided with technical assistance • Same goals maintained for next operation • 2 strike policy

  17. Measurement, verification and learning • Household and facility surveys to establish baselines, targets and attained results. • Completely external verification • Rigorous 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.

  18. Reflections

  19. A new way to provide aid? • Hands off approach if countries achieve results. • Technical assistance mandated if results are weak. • Pro- poor focus • Requiring that governments co-finance the initiative may contribute to sustainability • Country level incentives may catalyze broad system changes needed to achieve results

  20. To ponder • 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?

  21. VISITE OUR WEB www.saludmesoamerica2015.org “An innovative public/private partnership to reduce health equity gaps in Mesoamerica”

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