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“Cash on Delivery” to Improve MCH: Is it Feasible. Mead Over Center for Global Development Pay-for-Performance and Performance-Based Aid: at the Crossroads? International Workshop organized by the "Incentives for Health Provider Performance Network" UNIVERSITY OF AUVERGNE- CERDI
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“Cash on Delivery” to Improve MCH: Is it Feasible Mead OverCenter for Global Development Pay-for-Performance and Performance-Based Aid: at the Crossroads? International Workshop organized by the "Incentives for Health Provider Performance Network" UNIVERSITY OF AUVERGNE- CERDI CLERMONT-FERRAND – FRANCE May 11, 2011
Key Features of COD Aid • Rewards improvements in outcomes • Hands-off • Independent verification • Transparency • Complementarity with other aid programs Source: Birdsall&Savedoff (2010) http://www.cgdev.org/section/initiatives/_active/codaid
Basic steps of COD Aid • Two parties (donor and recipient) negotiate a 2 to 4 year contract specifying that donor will pay $X per HIV infection averted • Survey agency collects and reports HIV prevalence data using mutually agreed measurement methods • Donor commissions independent audit of measured output • Donor pays recipient according to achievement of previously negotiated output performance goals • E.g. $X per HIV infections averted • Government can spend money on ANYTHING (roads, football fields?) • Operational or impact evaluation research is strongly encouraged Source: Birdsall&Savedoff (2010) http://www.cgdev.org/section/initiatives/_active/codaid
Can it work in the health sector?Consider Maternal Mortality: • Maternal mortality is a primary target for Millennium Development Goal 5 Problem is the many health risks are rare: • In 2008, between 302,000 and 394,000 women died from maternal causes in LDCs (Hogan and others, 2010) • Compares to about 2,000,000 new HIV infections, of which perhaps two/thirds are among women
Four Opportunities to capture salient eventsfor an individual woman and her foetus
1. National Pregnancy Registration(Pilot in a district or region)
2. National Birth Regency(Piloted in the same district or region as the preganancy registration)
4. Survey of Random Sample of All Householdsin Region or District of Pregnancy & Birth Registrations
Four Opportunities to capture salient eventsfor an individual woman and her foetus
Opportunities to capture salient eventsfor an individual woman and her foetus
Next steps … • Use simulation model to explore sensitivity and specificity of various combinations of the four methods. • Propose possible sample contracts