Tajikistan - Feasibility Study for Results-Based Financing (RBF) In the Health Sector

World Bank

World Bank

关键词: ADMINISTRATIVE COSTS;    ANTENATAL CARE;    APPROPRIATE INCENTIVES;    AVAILABILITY OF DRUGS;    BASIC HEALTH SERVICES;   

RP-ID  :  53743

学科分类：社会科学、人文和艺术（综合）

来源: World Bank Open Knowledge Repository

【 摘 要 】

The purpose of this study is to examinethe feasibility of introducing Results-Based Financing (RBF)in Tajikistan's health sector. Several countries haveexperience with RBF in low-income settings, and lessonslearned can be interesting for Tajikistan. Technically, RBFis a retrospective provider payment that can be designed toreimburse providers for contractually defined services andspecific compliance targets, including for efficiency andquality targets. In Tajikistan RBF will be linked to ongoingprovider payment reforms. Therefore, the chapter alsoprovides a brief overview on provider payment mechanisms andexperience with provider payment reforms and treatmentpatterns from middle- and higher-income countries. Theobjective of this feasibility study is to propose asustainable RBF pilot program for two oblasts (Khatlon andSughd), to cost-effectively improve maternal and childhealth (MCH) outcomes. The study aims to inform the healthsector strategy and help the Government and partners toeffectively design and use RBF mechanisms at three potentiallevels. First, the fiscal transfer from the centralgovernment to oblasts (regions) and rayons (districts) couldbe adjusted to include a bonus payment based on specificresults achieved. Second, the provider payment method fromoblast health fund pools to hospitals and outpatientfacilities could reward providers based on resultsindicators. Third, a performance payment could be added tosalaries paid to staff working in health facilities. It isexpected that such a three-pronged approach could reinforcethe financial incentive set through RBF to staff working inthe administration and provision of care. If the staffresponds to these incentives, then this could lead to bettermanagement in oblast and rayons, improved availability offinancial resources and medical material in healthfacilities, and better treatment of patients. Combined,these behavioral changes will ultimately lead to betterhealth results, including improved quality of care and inthe longer-run improved health status.