No abstract

work is licensed under a Creative Commons IGO 3.0 AttributionNonCommercial-NoDerivatives (CC-IGO BY-NC-ND 3.0 IGO) license (http://creativecommons.org/licenses/by-nc-nd/3.0/igo/ legalcode) and may be reproduced with attribution to the IDB and for any non-commercial purpose. No derivative work is allowed.Any dispute related to the use of the works of the IDB that cannot be settled amicably shall be submitted to arbitration pursuant to the UNCITRAL rules. The use of the IDB's name for any purpose other than for attribution, and the use of IDB's logo shall be subject to a separate written license agreement between the IDB and the user and is not authorized as part of this CC-IGO license.Note that link provided above includes additional terms and conditions of the license.The opinions expressed in this publication are those of the authors and do not necessarily reflect the views of the Inter-American Development Bank, its Board of Directors, or the countries they represent. AbstractSalud Mesoamerica Initiative (SMI) is a unique results-based aid initiative that rewards countries for achieving health targets in the poorest municipalities in Mesoamerica. A partnership between private and public donors and governments, it offers lessons for philanthropists, corporate social responsibility teams, and bilateral donors about how to alter development assistance from the usual model of paying for inputs to a new one in which countries are paid for achieving results for their poorest populations. What makes this model of RBA feasible is its reliance on the staff, relationships, systems, and implementation capability of the Inter-American Development Bank and the dedicated unit that supports countries. Countries commit to achieve targets that progress from system readiness metrics to outcomes. Verification is based on externally conducted household and facility surveys. Five out of the eight countries achieved first-phase targets and received a performance payment, and all countries improved on key health system metrics.

Implementation research enabled stakeholders to formulate questions, assess implications of research results that informed changes in regulations and payment at the primary care level, and strengthen monitoring capacity. While the national health insurance system had some impact on performance of primary care facilities, individual providers remained unsatisfied because payment was largely based on factors outside of their control such as tenure and position, rather than their contributions to improved performance.

work is licensed under a Creative Commons IGO 3.0 AttributionNonCommercial-NoDerivatives (CC-IGO BY-NC-ND 3.0 IGO) license (http://creativecommons.org/licenses/by-nc-nd/3.0/igo/ legalcode) and may be reproduced with attribution to the IDB and for any non-commercial purpose. No derivative work is allowed.Any dispute related to the use of the works of the IDB that cannot be settled amicably shall be submitted to arbitration pursuant to the UNCITRAL rules. The use of the IDB's name for any purpose other than for attribution, and the use of IDB's logo shall be subject to a separate written license agreement between the IDB and the user and is not authorized as part of this CC-IGO license.Note that link provided above includes additional terms and conditions of the license.The opinions expressed in this publication are those of the authors and do not necessarily reflect the views of the Inter-American Development Bank, its Board of Directors, or the countries they represent. AbstractThe Salud Mesoamerica Initiative is a public-private partnership that provides funding to national governments in Mesoamerica (the region consisting of southern Mexico and Central America) that is conditional on attaining health results in their poorest municipalities. SMI has set into motion a dynamic process that is strengthening health systems for reproductive, maternal, neonatal and child health. The complementary and mutually reinforcing factors driving these changes include: reputational and financial incentives; competition among the participating countries; learning across national boundaries; external monitoring and the use of credible data to measure and reward results; technical assistance; and a sense of urgency created by the imposition of clear, time-bound performance goals. This results-based focus at the population level has also triggered changes in health systems that include: government commitment; strengthened leadership and operational management practices; enhanced coordination and collaboration between teams within the national ministries of health and between national and local levels in the health sector; new policies and norms focused on reproductive, maternal, neonatal and child health; health information data collection and analysis for decision-making and accountability; strengthened commodity management systems; increased demand for health services at community levels; and enhanced service delivery readiness. These system-strengthening measures are providing the foundation for the eight Mesoamerican countries to improve maternal and child health results among the poorest in the subsequent phases of SMI, when improved health outcomes will be rewarded. This results-based aid initiative contains unique features that offer lessons to strengthen other results-based aid initiatives and inform future donor partnerships with countries or between national and subnational governments.