发展中国家改善医保计划

Major donors are changing the way they fund health programs in low-income countries. The results in maternal and child health have been so successful that the World Bank and the Global Fund are working together to add programs on AIDS, tuberculosis and malaria. The change in financing focuses on motivating health care workers to provide better care and on helping patients obtain it.

When pregnant women get good health care and have a trained midwife or doctor at their side when giving birth, mothers and babies are more likely to survive.

And when children get vaccinated against preventable diseases and get quality care when they're sick, they're more likely to reach their fifth birthday.

The World Health Organization said that last year, 6.5 million children did not live to see their fifth birthday.

Children born in sub-Saharan Africa have the greatest risk of dying in their first five years. Most of the deaths are preventable.

The World Bank and other major donors have launched a plan to help children survive.

Tim Evans, who heads the program at the World Bank, said, “We want women to have access to ante-natal [post-birth] care. We want children who are born with a skilled birth attendant, with access to emergency obstetric care. If we want that coverage for the population, how do we organize the system and invest in it in such a way to achieve those results?”

The plan is called "results-based financing." It links incentives with results. For example, in some countries, women are paid to have their babies in a hospital. Midwives get extra money for delivering healthy babies. Doctors might get extra pay if they immunize a certain number of children.

The program provides incentives to direct medical care to patients or get the patient to the clinic.

"It’s a function of giving an incentive to those people on the ground to solve those problems, because the incentive for them is to achieve the results," said Evans.

Aid can also target programs in middle-income countries. Babies are most vulnerable in the first 28 days of life. The incentive program helped Argentina reduced infant deaths by 74 percent.

Since 2007, the World Bank has funded results-based programs in 31 countries, enough to see that the program saves lives and stretches donor funds.

The Bank is now collaborating with the Global Fund to Fight AIDS, Tuberculosis and Malaria - to help it adopt results-based financing in fighting these deadly diseases.

Other major funding groups also are studying the plan. Similar programs might help keep girls in school where they can learn job skills and, at the same time, discourage child marriages and prevent teen pregnancy. The end result would be healthier mothers and babies.