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Health Results-Based Financing Impact Evaluation and Monitoring: Technical Assistance for Health Measurement


The World Bank supported health results-based financing (HRBF) initiatives in selected low-income countries. Five countries began in 2009 (Eritrea, DR Congo, Rwanda, Afghanistan, Zambia), two in 2010 (Benin and Kyrgyzstan Republic) and one in 2011 (Ghana).  In this approach, governments or local organizations provided incentives that are linked to results, such as health worker bonuses for achievement of pre-determined intervention coverage targets, with the objective of improving maternal and child health and strengthening health systems. In order to generate evidence about the cost-effectiveness of the HRBF approach, impact evaluations were an integral part of the program in each country. Additionally, monitoring, documentation and process evaluation contributed valuable information about the strengths and weaknesses of this approach in different country contexts.

IIP provided technical assistance for the monitoring, documentation and process evaluation of HRBF activities, as well as technical support for the measurement of health-related outcomes. IIP worked with the Impact Evaluation Network at The World Bank, as well as the country teams in each pilot country.


The objectives of this project included:

  1. Development of indicators, measurement methods and protocols for outputs, quality of services, outcomes and impact related to maternal and child health; 

  2. Provision of technical assistance for adaptation of health measurement methods and protocols to specific country contexts; 

  3. Identification of different options, and their strengths and weaknesses, for assessing the reliability and validity of reported monitoring results used to trigger HRBF payments; and

  4. Development of standard instruments, protocols and reporting mechanisms for process evaluation and documentation of HRBF programs.


Funding to provide technical assistance for health measurement was provided to IIP through a grant from the World Bank, with support from the Health Results Innovative Trust Fund.