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[afro-nets] Results of RBF IBF Controlled Trial in Northern Uganda

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 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 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 complement 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 at:   <>


Jeffrey W. Mecaskey
Health Partners International
Mobile: +44 798 917 6063
Skype: mecaskey

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