Perspectives on Performance Based
Financing within the GAVI Alliance
Peter Hansen
Clermont-Ferrand, 11 May 2011
Performance Based Financing (PBF) within
the GAVI Alliance
 Operates on two main levels:
 Between GAVI and national government (‘aid’):
Immunisation Services Support (ISS)
 Between national government and lower levels,
civil society and communities (‘financing’):
Health Systems Strengthening
 Future directions
 Grant monitoring framework
 Health Systems Funding Platform
 Incentives for Routine Immunisation
Strengthening (IRIS)
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11 May 2011
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Draft Grant Monitoring Framework
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11 May 2011
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Health Systems Funding Platform
 ‘Financing’ – platform to be used to finance
PBF initiatives within many countries, based
on national health strategies
 ‘Aid’ – options/modalities are in development
 Options to be explored to deliver all cash
based programmes within GAVI through
platform
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IRIS
 Objectives
 Increase routine immunisation coverage
 Increase equity in immunisation coverage
 Structure
 National governments submit applications to
GAVI
 Must specify detailed plan describing how
incentives would be pushed down to lower
levels of the system
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IRIS
 Builds on ISS design and lessons learned
 Key Changes
Incentives distributed to lower levels of system
Portion of grant “fixed” (process measures) and
portion “at risk” (outcome measures) each year
Performance payments linked to coverage (and
possibly equity) rather than number of children
immunised
Enhanced and independent validation of results,
linked to WHO/UNICEF estimates
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Payments under IRIS – hypothetical example
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What has worked in using PBF within GAVI?
PBF has helped catalyse achievement of better
results in many countries
Positive feedback from countries
Clarity, flexibility, autonomy, ownership, encourages
innovation, low transaction costs and reporting burden
Reduced transaction costs at global level
Leaner model means more money to finance results
at country level
ISS pathfinder effect
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Lessons learned
If incentives are wrong, potential to distort behaviour
Be explicit about theory of change and put it to the
test
Actively identify and document unintended
consequences
Need to ensure appropriate balance between:
Data integrity, country ownership and capacity
strengthening
Quantitative rules and responsiveness to context
Predictability and results orientation
Rewarding good performance and addressing needs of
low performers
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