Discussion points - RBF Health

Discussion points - 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 DPs 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 Financial vs Economic Costs Implementer vs Societal Costs Fixed Costs vs Recurrent Short Term vs Long Run (Mature) EVIDENCE ON COST EFFECTIVENESS IN PBF IN HEALTH: LESSONS FROM EARLY ADOPTERS: FINDINGS & FRONTIERS Zimbabwe ICER: Highly cost-effective

Coverage: $663 or < $980 GDP/capita (2012) C + Quality: $439 < $980 GDP/capita (2012) Start-up vs. Mature Project Costs Assumptions (e.g. attrition, risk-based verification) Tanzania PBF example (Borghi et al., 2014) 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

Variations in Costs, Cost Drivers SENSITIVITY ANALYSIS Variations in Lives Saved (2014) Comparison & Learning Cordaid & Crown Agents Sustainability Evaluations impact on GOZ Policy and Donors Zambia ICER: Highly cost-effective RBF vs INP: $1,350 < $1,759 GDP/capita RBF vs CON: $874 < $1,759 GDP/capita INP vs CON: $507 < $1,759 GDP/capita RBF vs INP No clear dominance Coverage Impact: RBP < INP for 2 highest incentivized targets (Ins Del, PNC)

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

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