Under the Health Services Improvement Project (HSIP), the World Bank commits to support the implementation of a results-based financing (RBF) scheme through the Free Maternal and Child Health (Free MCH) programme. The RBF scheme reimburses public facilities for the provision of complete maternal package and prevention and promotion services for children under five. Additionally, it reimburses clients for their costs of transport and accommodation and provides an incentive for completing the antenatal care regimen.
The RBF scheme runs alongside the Free MCH programme, which is seen as another approach to effectively achieve health system goals and reduce financial barriers of the poor. It has the objective of improving attendance of pregnant women and children under five and improving the accountability of service providers. It works through a voucher system.
The focus of EPOS’ work is to do a third-party audit that assesses the completeness, accuracy and validity of self-reported and internally verified data on service delivery performance. Provision of reimbursements and incentives to facilities is done on the basis of their compliance to agreed-upon performance indicators. The district health offices conduct the internal verification and authorize the release of funds. EPOS then conducts external verification among districts and health providers participating in RBF.
Core methods being conducted include a review of detailed records, investigations with patient beneficiaries, as well as a thorough assessment of piloted quality indicators associated with the RBF interventions. The external verification approach is thus split into three primary components:
-External “book audit” (detailed review of facility records – including internal verification reports – based on quantity and quality indicators under Free MCH and HEF);
-Client Tracer of Patient Beneficiaries (“patient spot checks” of receipt of services under Free MCH and HEF)
-Verification of facility assessment done on the basis of quality indicators for "Paying for Quality"
EPOS’ contribution to advancing the RBF scheme in Laos is two-fold. First, external verification accurately rewards facilities for achieving the stated goals of the RBF mechanism. Secondly, it provides an opportunity to strengthen facility manager and clinical staff skills in the overall administration and financing of health services. Part of EPOS’ task is to develop a strategy for instituting corrective measures, and finding solutions to problems once identified in collaboration with government and facility staff.