Transcript - RBF Health

DISCUSSION POINTS
COST-EFFECTIVENESS OF RESULTS-BASED FINANCING
PROGRAMS IN ZIMBABWE AND ZAMBIA, HRITF BBL,
NOVEMBER 3, 2016
Edit Velenyi, PhD, Sr. Economist
STATE OF CEA IN PBF IN HEALTH? – A GLASS ….
MOH
MOF
Half Full
 1st Applied CEA Toolkit
 2 Empirical Studies in
HRITF Portfolio
 Promising ICER results
 Precedent to avalanche?
 Trust
 Tools
 Implementation research
to inform design and
management.
Half Empty
 Sea of Effectiveness vs. Islands of CEA
 “Back of the envelope CEA”
 Focusing on things that are easier (less
controversial) to measure and easier to
publish.
 IEG asked – Why (ROSES, 2016)?
 Risk Aversion: Political Risks
 Evaluation Skills (CEA Experts)
 Operational Challenges
 Data Sources
 “Audit”
 Sensitivity of CEA Conclusions: “It depends”
 Approach
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Financial vs Economic Costs
Implementer vs Societal Costs
Fixed Costs vs Recurrent
Short Term vs Long Run (Mature)
DPs
EVIDENCE ON COST EFFECTIVENESS IN PBF IN HEALTH:
LESSONS FROM EARLY ADOPTERS: FINDINGS & FRONTIERS
Zimbabwe
 ICER: Highly cost-effective
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Coverage: $663 or < $980 GDP/capita (2012)
C + Quality: $439 < $980 GDP/capita (2012)
 Start-up vs. Mature Project Costs
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Assumptions (e.g. attrition, risk-based verification)
Tanzania PBF example (Borghi et al., 2014)
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Cost: FC = $1.2 million EC = $2.3 million
IC/Additional Facility Based Birth PILOT = $540-$907
IC/Additional Facility Based Birth NATIONAL = $94-$261
 Impact
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Variations in Costs, Cost Drivers – SENSITIVITY ANALYSIS
Variations in Lives Saved (2014)
 Comparison & Learning
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Cordaid & Crown Agents
 Sustainability
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Evaluation’s impact on GOZ Policy and Donors
Zambia
 ICER: Highly cost-effective
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RBF vs INP: $1,350 < $1,759 GDP/capita
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RBF vs CON: $874 < $1,759 GDP/capita
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INP vs CON: $507 < $1,759 GDP/capita
 RBF vs INP – No clear dominance
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Coverage Impact: RBP < INP for 2 highest incentivized
targets (Ins Del, PNC)
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Quality Impact: ? Issue: Complexity of Target (FP vs ID)
 Counterfactuals / D-Side Complements
 Vouchers
 CCT
 Health Insurance
PUSHING THE CEA FRONTIERS
1.HRITF Portfolio Level
 Effectiveness: Generations of effectiveness studies and ambition for meta analysis (despite heterogeneity)
 CEA: What is the ambition?
 What are the lessons from the early adapters in operationalizing / implementing CEA?
 Can Clients/Task Teams draw on data
 New countries to scale
collection tools and “how-to” tips to jump start CEAs?
the experience? Willingness to test alternative CEA methods?
2.Client Perspective
 Is there support to use existing data or collect additional data for CEA?
 Are findings from CEAs’ used to inform program adjustments, scale up, and allocation decisions?
PUSHING THE CEA FRONTIERS …
3. Broader Development Context
For example, DFID V4M (2011)
SDGs
UHC
V4M
MFM
 “V4M does not mean we only do the cheapest things, but we
do have to get better at understanding our costs.”
 “We do not just do the easiest things, but the agenda does
mean we have to get better at measuring.”
 “Countries play a critical role in delivering results.”
 “We care about the results achieved with all
development resources, not just our own.”
Despite the increased importance of V4M, there is little evidence on CEA in PBF.
USE CEA TO INFORM CHOICES & INCREASE IMPACT
K/D Ratio
Cost/Lives Saved