Abstract
The World Bank, co-funded by Norway and the United Kingdom, created and managed an innovative financing mechanism, the Health Results Innovation Trust Fund (HRITF), to support performance-based financing (PBF) reforms in low- and middle-income countries. From its inception in late 2007, until the closing of fundraising in 2017, it has carried out a wide range of activities related to experimenting PBF. In conjunction with the World Bank, which positioned itself as a “learning organisation”, donors have pushed the HRITF towards developing a specific learning agenda for documenting the policy impact of PBF. This learning agenda has been primarily based on impact evaluations of PBF pilot programmes. As a new body took over the HRITF’s portfolio (Global Financial Facility),a documentary analysis of this learning agenda is timely. Building from public policy concepts that have been applied to social and health policy, and knowledge translation literature, we examine the learning agenda implemented by the HRITF over these 10 years. Our data includes documentation and publications (N=35) on HRITF and from the HRITF online platform. Results indicate that on several fronts, the HRITF shaped some form of politicised knowledge, notably in the ways country pilot grants were designed and evaluated. Some of its learning activities also provided opportunities for a transformative use of knowledge for World Bank staff as well as national implementers and policymakers. We also provide reflections about the HRITF’s preferred approaches to produce knowledgeand learn.
Highlights
The need to develop and use knowledge on the impact of healthcare system policies is a critical strand of work of major global health organisations
Results indicate that on several fronts, the Health Results Innovations Trust Fund (HRITF) shaped some form of politicised knowledge, notably in the ways country pilot grants were designed and evaluated
The HRITF had an explicit learning agenda primarily based on these impact evaluations of performance-based financing (PBF) pilot programmes (Schneider, 2014): “a well-funded impact evaluation portfolio underpins HRITF’s comprehensive learning agenda” (RBF Health, 2016b)
Summary
The need to develop and use knowledge on the impact of healthcare system policies is a critical strand of work of major global health organisations. For the past 20 years, many healthcare financing strategies to improve supply, demand, and access to health services have been promoted and funded by international donors.These are piloted and scaled-up in spite of uncertainty as to their impact and effects on health systems.A report by the World Health Organization (World Health Organization, 2013) on achieving universal health coverage (UHC) – which, among all these strategies, has been winning donors’ attention – emphasises critical research gaps to be addressed. Pilot programmes of PBF have multiplied over the past fifteen years inLMICs.These programmes have been promoted, designed, funded, implemented, and evaluated by global actors (i.e., multilateral and bilateral donors, and non-governmental organisations) (Gautier; Ridde, 2017).
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