Mid-term performance evaluation for health sector financing reform/health finance and governance (HSFR/HFG) activity

HSFR/HFG aims to address this challenge. This midterm evaluation used mixed methods to assess the activity"s performance based on two evaluation questions: (1) To what extent are HSFR/HFG"s theory of change and objectives adequate, relevant, and viable?; and (2) What progress has been made towards achieving the activity"s performance objectives by focusing on relevance, effectiveness, efficiency, and sustainability? The activity design and interventions were found to be relevant, adequate, and viable in improving the quality and responsiveness of care by facilities, addressing community needs, and being fully aligned with government policies and strategies. The interventions effectively reduced financial barriers to healthcare, especially for women and the very poor, and in enhancing their voices to demand for accountability. Outpatient service utilization by community-based health insurance (CBHI) members and by the public surpassed the set targets. This was achieved with a declining share of out-of-pocket health care spending by households and improved patient satisfaction rates. In most facilities assessed, lack of financing is no longer the prime cause of inadequate medical supplies. A total of 2.41 million households were enrolled in CBHI. About 1.8 million poor households benefited from increased protection. Moving forward, revenue retention and utilization at facilities, governance boards, fee waivers, private wings, and outsourcing of non-clinical services can be sustained without significant activity support. However, some design and implementation challenges pose risks for the sustainability of CBHI. The activity should focus on implementing a supply-side exit strategy that prioritizes building local institutional capacities and systems, particularly at the regional level. (Author abstract, modified)