The Role and Effect of Decentralization Using Results-Based Financing in Honduras

Presentation at the Global Maternal Newborn Health Conference, October 20, 2015

Background: Since 2004, the Ministry of Health of Honduras (SESAL) has been undergoing various phases of health-sector reform. Separating the stewardship role from the provision of services through decentralization has been fundamental in this process. As part of the reform, public funds managed by the SESAL are dispersed using results-based financing (RBF) mechanisms to primary-care decentralized management teams (Gestores). Currently the new model covers 1 million people.

Methodology: Gradually the SESAL began to decentralize primary healthcare services by contracting Gestores to provide a basic packet of services (BPS) in the poorest areas of the country, moving from contracts with individual health centers to “health networks” managed by the Gestores. Contracts are signed with Gestores based on a set of quality and coverage indicators, externally verified quarterly. Payment depends on capitation, in addition to providing an incentive for good performance (10%).

Results: Cost-effective analysis comparing traditional to RBF methods revealed the RBF model was more cost-effective (Measure Evaluation and Prodim, 2008), and Vellez, 2010 and Prado and Leno, 2010, both conclude that units with the BPS demonstrated higher levels of production and increased coverage of the target population. Coverage in hard-to-reach areas increased by 24%. Challenges include linking decentralized primary services with centralized secondary and tertiary services.

Conclusions: Decentralization has been proven effective in hard-to-reach areas; therefore, the SESAL is currently undergoing the process to scale up this model to 4.8 million people, in addition to applying to expanding the results-based focus to secondary levels of care.