Management Science for Health's (MSH) goal is to save lives and improve health by expanding access to high-quality, efficient health care services by improving health systems and the management of services. MSH manages and supports performance-based financing (PBF) of health programs to focus on investing in results rather than the process. Performance-based financing is a mechanism that ties payments/incentives to verifiable program and health results. MSH will work with the governments of Ethiopia, Haiti, and Rwanda to improve access to and quality of health care through PBF.
MSH's goal is to provide access to and improve quality of health care for people in Rwanda, Ethiopia, and Haiti through the teaching, replication, and support of PBF. They will capture lessons learned and best practices in order to help further promote PBF initiatives throughout the world.
Specifically, they seek to:
- Expand the pool of professional PBF implementers.
- Support linkages between communities and the health system, establishing local, regional, and global voices in service management and resource allocation.
- Promote community co-management of the health system.
- Reward innovation and productivity.
- Leverage and improve management of locally and globally generated resources through activities that strengthen governance.
As the projects conclude, MSH expects to share results with the larger development community through international conference participation, speaking engagements, professional journals, and white papers.
Rwanda: The project will positively affect 2 million lives. From 2005 to 2007, the contraceptive prevalence rate increased from 10 percent to 27 percent, the mortality rate for children under five fell from 152 to 103 per 1,000, and HIV and counseling increased by nearly 200 percent.
Haiti: The project will deliver integrated services to half the population. A total of 4.5 million lives will be positively affected, specifically 93 percent of children under one will be fully immunized and 50,000 pregnant females will be tested for HIV.
Ethiopia: The project works in 5 regions in Ethiopia with a total population of about 35 million people (the country has 12 regions and 77 million inhabitants). The overall direct results of the project: 330,000 individuals receiving basic palliative care; 70,000 patients receiving treatment for tuberculosis (TB); 500,000 individuals counseled and tested for HIV; 47,000 pregnant women are registered in antiretroviral treatment (ART) health centers; and 95,000 new HIV+ individuals receiving ART in the same three-year period.
Actions to be taken:
MSH will work with the Ministry of Health to establish a Young Professionals Program that will create practical opportunities for new graduates of Rwanda's School of Public Health.
MSH will run a PBF training course in January 2009. The course qualifies international professionals to provide technical assistance to other PBF locations.
The community PBF program will impact rural populations, improve engagement in and support to the health system for over two million people. It will greatly strengthen community involvement in efforts to control HIV/AIDS and TB.
MSH will work with partners to link communities directly with important economic actors in Haiti via a PBF system. The project will improve the utility and impact of commercial investments and improve the sustainability of the health services.
Local PVO and private commercial sector partners in Haiti are committed to be used in alignment with our field initiatives through joint planning, shared expenses of activities, and shared public sponsorship/accountability for outcomes.
The program in Haiti will help 1.5 million people gain access to quality health services.
MSH will work with three levels of NGOs in Ethiopia to implement the program. The first level are mentoring NGOs, they have experience and skills to function nationwide as technical partners and will mentor a larger number of implementing NGOs. The implementing NGOs, are smaller organizations that work within a region or cluster, they provide critical services at the community level. The implementing NGOs will mentor smaller CBOs, FBOs, Idirs (traditional burial societies), and community groups. They will provide the direct services at the community and family levels.
This new initiative is scaling up with the goal of formally establishing a functioning planning group of private-sector partners. Individually, some of these partners have already co-sponsored major activities and events with MSH's SDSH Project, funded by USAID. The vision for this scale-up is a core group, a partnership between civil society and the private sector, to attract and channel financial and professional resources in order to benefit the people of Haiti. It is a promising model for establishing a sustainable resource flow that is fully owned and guided by the people of Haiti. As the community PBF initiative is established, these resources can eventually flow directly to network NGOs and/or local health task forces.
Performance-based contracting (PBC) is one of the Ethiopian Government's key strategies to improve health services. PBF is used to involve private organizations in a coordinated effort to expand service nationwide while providing technical assistance to the Government of Ethiopia to implement performance-based financial programs in the public sector.
In Rwanda: The Government of Rwanda Ministry of Public Health, the Belgian Technical Cooperation, and US Agency for International Development.
In Haiti: The Government of Haiti Ministry of Public Health and Population, US Agency for International Development, voluntary organizations.
It is helpful to have partners and funding support to bolster resource streams that directly benefit communities. Partnerships with other groups or private-commercial-sector interests can accelerate a dynamic process of permanently rooting PBF in these countries, as well as others.
MSH will meet and exceed its commitment. We welcome new partners and information that can improve impact. We are well organized to channel resources into useful programs that achieve results. We will be happy to support CGI outreach activities with concrete examples of program that have impact.
MSH has many useful methodologies to improve access to and quality of health services. We will be pleased to share these approaches with new partners.