Results-based aid (RBA) is increasingly used to incentivize action in health. In Mesoamerica, the region consisting of southern Mexico and Central America, the RBA project known as the Salud Mesoamérica Initiative (SMI) was designed to target disparities in maternal and child health, focusing on the poorest 20% of the population across the region.
Methods and findings
Data were first collected in 365 intervention health facilities to establish a baseline of indicators. For the first follow-up measure, 18 to 24 months later, 368 facilities were evaluated in these same areas. At both stages, we measured a near-identical set of supply-side performance indicators in line with country-specific priorities in maternal and child health. All countries showed progress in performance indicators, although with different levels. El Salvador, Honduras, Nicaragua, and Panama reached their 18-month targets, while the State of Chiapas in Mexico, Guatemala, and Belize did not. A second follow-up measurement in Chiapas and Guatemala showed continued progress, as they achieved previously missed targets nine to 12 months later, after implementing a performance improvement plan.
Our findings show an initial success in the supply-side indicators of SMI. Our data suggest that the RBA approach can be a motivator to improve availability of drugs and services in poor areas. Moreover, our innovative monitoring and evaluation framework will allow health officials with limited resources to identify and target areas of greatest need.
William Gardner, Christian Razo, Theresa McHugh, Nicholas Kassebaum, Christopher J.L. Murray, Simon Hay, Hailey Hagins, Victor Vichis Tella, Conor Hennessy, Heather Taylor, Nandita Perumal, Kia Fuller, Kelly Cercy, Leo Zoeckler, Catherine Chen, Stephen Lim, Aleksandr Aravkin, Michael Arndt, Jessica Bishai, Katrin Burkart, Eunice Chung, Xiaochen Dai, Lalit Dandona, Rakhi Dandona, Samath D. Dharmaratne, Maegan Dirac, Sam Ewald, Ryan Fitzgerald, Mohammed Hassen, Tomislav Mestrovic, Ali Mokdad, Hasan Nassereldine, Brandon Pickering, Reed Sorensen, Jeff Stanaway, Peng Zheng