KIT Royal Tropical Institute, at the request of the Malian Ministry of Health (MOH), has undertaken action-research in order to develop a model for results-based financing (RBF) in the Koulikoro Region of Mali.
Better financing to reduce maternal mortality
Across Africa all avenues are being explored in order to achieve the most problematic of the ten Millennium Development Goals (MDG): Reduction in Maternal Mortality (MDG5). Malian Ministry of Health (MOH) officials observed the effectiveness of RBF in Rwanda and decided to develop “RBF à la Malienne”.
RBF partially replaces ex ante budget agreements with ex post facto service payments. RBF is a contract between purchaser, in this case the province or Commune, and provider, in this case the ASACO (community health association).
A regulator (the MOH) ensures that results fulfill national standards. Payment is related to output so an independent organisation verifies the reported results in communities and health centres. The Commune also holds the ASACO to account in terms of service delivery. In this way RBF empowers the community.
Successful pilot amid political turmoil
The pilot scheme took place against a backdrop of coup d’état, civil war and foreign military intervention. Eight service types were funded using RBF. Five payments were made at three month intervals. The results were verified and were sufficiently impressive to convince the Steering Committee of the MOH to advocate increasing the health budget to allow for nation-wide RBF.
External consultancies increased by 35%, there was an almost five-fold increase in the use of clinics for the under fives and quality was judged to have increased from 67% to 83%.
In terms of MDG5: antenatal care increased more than eight-fold, family planning attendance increased almost four-fold and births by skilled personnel in well equipped health centres increased by 60%. Quality of care for maternal services rose from a 28% to 84%.
These results demonstrated relaxation of restrictive local custom which would normally prevent women giving birth outside the home or receiving help with family planning.
“RBF is like a medicine, a good remedy that is worth the big support of the joint actors at different levels of the health sector. The instruments developed are important and of such high quality that we should continue using and improving them in relation to the circumstances to guarantee the quality of health services.”
Regional Health Director in Koulikoro