Result Based Financing in
Ethiopia
Program for Result
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Background
• The new Program for Results (PforR) financing
instrument is a new lending mechanism which
was applied since 2013 in the Ethiopian Health
sector
• The PforR instrument makes the Bank’s
contribution more responsive to present needs in
Ethiopia
• Disbursement is based on achievement of eight
agreed upon DLIs
• The achievement of these DLIs are measured at
national level not sub-national level
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Background
• The program development objective (PDO) is
to improve the delivery and use of a
comprehensive package of maternal and child
health services.
• The PDO is a subset of the strategic objectives
of HSDP IV that focus on improving access to
health services and evidence-based decision
making by harmonization and alignment
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Scope of the program
• The fund from PforR operation will support
activities under the MDGPF with exception of
the high-value procurement
• The MDGPF has supported financing gaps in
maternal health, child health, capacity
building of health extension workers and
strengthening of health systems such as HR,
Construction and equipping of health
facilities.
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Key program results for PforR
– (i) antenatal coverage (%);
– (ii) deliveries attended by skilled health providers
(%);
– (iii) Pentavalent 3 vaccine coverage for children
aged 12-23 months (%); and
– (iv) contraceptive prevalence rate (%).
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DLIs
DLI
Verification mechanism
Deliveries attended by skilled birth providers (%)
Mini DHS, DHS
Children 12-23 months immunized with Pentavalent 3
vaccine (%)
Cluster survey (twice during
the project period)
Pregnant women receiving at least one antenatal care visit
Mini DHS, DHS
Contraceptive Prevalence Rate (%)
Mini DHS, DHS
Health Centers reporting HMIS data in time
RDQA (every six months)
Development and implementation of Balanced Score card
approach to assess facility performance and related
institutional incentives
Separate implementation
report
Development and implementation of Annual Rapid Facility
Assessment to assess readiness to provide quality MNCH
services
SPA, SARA (Survey reports)
Improved transparency of the Pharmaceutical Fund and
Supply Agency (PFSA)
Independent consultant
report
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Question 1
• Are the current and proposed P4R schemes
well aligned with national strategic plan and
its targets and indicators?
– PforR is aligned with national strategic plan and
targets because once it is disbursed it is managed
as per the JFA which bases its plans on the
strategic documents. The targets for PforR are set
based on the national strategic documents.
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Question 2
• What have been the challenges in getting
them aligned?
– The challenges are the fact that PforR uses parallel
verification mechanism and the sector needs to
coordinate or fund those verification systems
– The high value procurement is not allowed so the
PforR fund is put in a sub account
– There are numerous POA to be followed up and
these require a lot of time and energy
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Question 3
• Have P4R schemes been designed to strengthen and
increase use of national systems, especially reporting and
information systems? How have demands for monitoring
and verification been managed?
– Yes the PforR uses the government system to plan,
implement and report. The only addition is that it has
separate triggering mechanism to ensure disbursement.
– The verification mechanisms are demanding, resource
intensive and put a lot of burden on the government
system.
– MOH negotiated with CSA and EPHI to work on the miniDHS and also the facility survey (SPA+)
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