Scaling up results-based financing in Malawi

We are working with the Reproductive Health Directorate within the Ministry of Health to manage and implement the Results-based Financing for Maternal and Newborn Health Initiative (RBF4MNH). The Initiative supports the Malawi government to address factors contributing to the high number of maternal and newborn deaths.

Using performance-based and demand-side financing approaches, our programme is helping to improve the quality of services as well as the number of patients using them. Women from poor rural areas are given money to pay for transport and other related costs so that they are able to stay in the facility for 48 hours after having their baby. The programme also financially rewards good performance of health care workers and health facilities and has funded minor infrastructure and rehabilitation improvements, contributing to a better quality of service provided.

In May 2016, a group of international, regional, and national delegates came together for the Results Based Financing for Health (RBF4H) Strategic Workshop “Generating a Roadmap for Results-based Financing for Health (RBF4H) in Malawi” in Lilongwe, Malawi. The workshop was convened by the Malawi Ministry of Health (MOH) with support from the German Government, through KfW, and the Royal Norwegian Embassy (RNE). The workshop focussed on identifying key RBF elements that could be integrated into the Malawi Health Sector Strategic Plan (HSSP) and scaled-up, as well as developing and agreeing important next steps for the integration of RBF into the HSSP II process.  Both the government and development partners present confirmed their commitment to results-based approaches more broadly.

In his opening speech, the Minister of Health, the Hon. Dr. Peter Kumpalume, M.P. discussed the challenges that the health sector was facing and acknowledged the positive results that the RBF4MNH Initiative has achieved in improving quality of care for mothers and babies.

Workshop participants included the German Government (German Embassy and KfW), the Royal Norwegian Embassy, NORAD, USAID – TRAction, World Bank, Options – with representation from Malawi and London, SSDI – Jhpiego, Abt. Associates, MOH – representatives from national, zonal, district and facility teams, academia, Traditional Authorities (TAs), District Councillors, and media.

Robust evidence is critical to inform decision-making and the key note session at the workshop was the dissemination of the results and analysis from the team at the University of Heidelberg who led an external evaluation of the RBF4MNH Initiative, working with the Malawi College of Medicine. Other sessions included a presentation by a senior representative from the Ministry of Health on the Health Sector Strategic planning process, and presentations by the World Bank on results-based financing interventions in Zambia and Zimbabwe, as well as on the Global Financing Facility.

Participants at central, district, facility and community levels also shared their experiences in implementing the RBF Initiative, and there was lively discussion comparing and contrasting the two different RBF models in the Malawi health sector.  The focus on building ownership and embedding the project in systems and structures at the district level, in line with the decentralisation policy of the Malawi Government, was an acknowledged success of the German and Norwegian-financed RBF4MNH Initiative.

The discussions strengthened the support from the Ministry of Health to plan for the possible scale-up of RBF in the health sector.  However, given the current economic climate, lack of domestic financing available for new initiatives and the need for additional external support is also an issue causing concern. Our team is working with our partners to further define the roadmap for the integration of RBF elements into the HSSP II, building on the commitment from Government (MOH) to incorporate results-based financing into health sector policy documents.

The Results-Based Financing for Maternal and Newborn Health (RBF4MNH) Initiative is funded by KFW and implemented by the Malawi Ministry of Health (MOH); Options manages the funds on the Ministry’s behalf and provides technical expertise for implementation.