Author: Jeffrey Mecaskey, October 16 2015 - National and international health policy and financing experts and Ugandan political leaders met in Kampala to review evidence and insight from a novel study to assess the costs and benefits of results-based financing versus input-based financing in Northern Uganda.

With the Sustainable Development Goals, the UN [United Nations] Secretary General’s revised Global Business Plan for Maternal and Child Health, and the World Bank-hosted Global Financing Facility, there is a renewed imperative in understanding how Results Based Financing (RBF) can improve efficiency, effectiveness and accountability in programming towards Universal Health Coverage and improved health outcomes at scale. There is a growing body of experience in a range of RBF-related programmes, but there remain key gaps in the evidence including how cost-effective programme approaches can be adapted to circumstances of fragility, poor governance and weak systems, where unmet need in reproductive, maternal, newborn and child health is often greatest. 

Funded by UK [United Kingdom] aid from the UK government and implemented by Montrose International and Health Partners International, Northern Uganda Health (NU Health) is a controlled implementation study to assess the costs and benefits of RBF relative to conventional Input Based Financing (IBF). The study design aimed to isolate the main effect of the financing modality in terms of quality and quantity of health service provision.  Programme data and the results of an independent evaluation conducted by Liverpool School of Tropical Medicine confirm a range of key findings.  These include: 

•               A significant reduction in barriers to access and increase in health service utilisation in the RBF v IBF arms;

•               A massive three to eight fold improvement in adherence to standard treatment algorithms/quality of care for the major childhood killers:  diarrhoea, malaria and pneumonia in the RBF v IBF arms;

•               Particularly dramatic improvements in care and utilisation at the lowest level facilities, harbouring the promise of real progress toward Universal Health Coverage in the RBF v IBF arms; and,

•               Insight into the systems capabilities required to scale up and achieve population health improvements at scale. 

Evidence, experience and insights arising from NU Health is summarised in a set of three publications, with the independent assessment report to be available soon.  The NU Health Policy Brief is aimed at decision makers and provides a concise outline of the implications for policy and programme arising from NU Health.   The second publication, the NU Health Insights Report, is aimed at programme planners and managers and provides a practical summary of the key learnings from NU Health, with greater detail on context, design and learning.  Finally, the third publication, the NU Health Technical Annexes, is aimed at technicians and investigators and complements the NU Health Policy Brief and NU Health Insights Report to provide additional detail on the approaches, methodologies and evidence presented in those documents. They provide an overview of insights generated over the course of the programme, with the aim of informing programme efforts by other health service providers, government agencies or cooperating agency partners.  These may be found by clicking here.