Implications for Incentivizing Health Outcomes in South Sudan: An Assessment of a Results-Based Financing Project in the Jonglei and Upper Nile States Open Access

Abstract

With few national resources, poor health outcomes, and a dire need for increased financial commitments to the Ministry of Health, South Sudan has turned to international donors to support and grow their health system since independence in 2011. While sustainability and country ownership are ultimate goals, a weak economy, tenuous political leadership, insufficient infrastructure, and a feeble health services workforce have created a multitude of opportunities for the international community to offer assistance. The introduction of innovative financing mechanisms since the inception of the Millennium Development Goals in 2000 has attempted to improve both health outcomes and health systems simultaneously. IMA World Health first implemented the Rapid Results Health Project (RRHP) in South Sudan in 2013 in an effort to improve health outcomes among the 3.3 million people throughout the Jonglei and Upper Nile states. RRHP introduced results-based financing (RBF): a mechanism used to provide the healthcare workforce with financial incentives to increase and improve their health service provision by achieving key performance targets. Keeping in line with the limited and inconsistent literature on RBF, an assessment of RRHP data showed inconsistent results across multiple indicators used to measure project management and health outcomes. Despite the inability to draw any statistically significant conclusions from the available data, the Rapid Results Health Project presents many learning opportunities for current and future results-based financing initiatives. Because effective, innovative health financing is a critical aspect of health systems strengthening, continued and improved monitoring and evaluation of results-based financing initiatives can have a strong impact on the future of public health.

Table of Contents

CHAPTER 1: INTRODUCTION........................................................................................1

South Sudan.................................................................................................................1

Results-based Financing................................................................................................5

IMA World Health.........................................................................................................7

Rapid Results Health Project..........................................................................................8

Problem statement.......................................................................................................9

Purpose Statement......................................................................................................10

Research Questions.....................................................................................................10

Significance Statement................................................................................................10

Definition of Terms.....................................................................................................11

CHAPTER 2: LITERATURE REVIEW..............................................................................12

Background................................................................................................................12

Effects on Maternal and Child Health...........................................................................13

Does Context Matter?.................................................................................................14

How is Effectiveness Measured?...................................................................................16

Effects on Quality.......................................................................................................16

Sustainability.............................................................................................................17

Equity Weights in the Nigeria State Health Investment Project......................................19

CHAPTER 3: METHODOLOGY.....................................................................................21

Ethical considerations.................................................................................................25

Limitations.................................................................................................................25

CHAPTER 4: RESULTS.................................................................................................28

CHAPTER 5: DISCUSSION & CONCLUSION..................................................................35

REFERENCES.............................................................................................................44

TABLES AND FIGURES................................................................................................47

About this Master's Thesis

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School	Rollins School of Public Health
Department	Hubert Department of Global Health
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health
Keyword	incentives South Sudan results-based financing
Committee Chair / Thesis Advisor	McFarland, Deborah A, Emory University
Partnering Agencies	International Non-governmental organization (e.g., CARE, Inc.)

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