MaxPBR, a hybrid payment-by-results model combining programme monitoring with financial incentives, is measuring, monitoring and managing for greater results in tackling child stunting. Our advanced use of data monitoring of every beneficiary enables:
• Beneficiaries to co-create and gain ownership of local interventions
• Implementing partners to innovate and adapt in real time to increase effectiveness
• Next steps in impact measurement, strengthening the causal chain in service delivery
#MaxPBR (programme management&financial system) puts our money where our (data) measurement is, for maximum impact on child health in Bangladesh
What problem are you trying to solve?
800+ children die daily from preventable diseases. Over 24% of children under five are stunted, linked to poor hygiene and nutrition. Stunting limits life potential – with long-term effects on cognitive and physical development, health and livelihoods. Improving well-being by tackling complex child health issues like stunting are exactly what the interconnected SDGs are all about. But doing so requires to focus on effective results and the need for a sector shift away from traditional input-based focus (e.g. on activities) to verified, pre-defined outputs, outcomes and impacts. And for agile approaches that allow change to improve effectiveness – locally led, with input from those most affected. The pressure is on to demonstrate results from donors, governments and communities seeking to be included in decision-making. Monitoring and data are under-used as a tool for steering, learning or empowerment, leading to missed chances for improving efficiency and ultimately impact.
What is your solution to this problem?
MaxPBR is a real-time, data-rich monitoring and financial system. It supports our Max Healthy Village programme which will reach 1.3 million people with integrated WASH+nutrition, providing a healthy start in life for over 100,000 children under five in Bangladesh by 2021, by reducing stunting and diarrhoea. We place measuring results at the core of the programme and aim for full coverage. Local mentors and health promoters use mobile- and web-based apps to continuously gather data on all beneficiaries/ change agents: e.g. on child growth and weight, families’ investment in improved sanitation, local entrepreneurs’ sales records. This data is available (anonymized) to stakeholders, to motivate communities to become Healthy Villages; for data-informed, responsive interventions; is linked to a financial system where partial payment to local partners is upfront and the rest on verified results. We aim to incentivize innovation and more freedom to stakeholders in managing local solutions.
What is your latest update on your innovation?
We have developed mobile- and web-based applications in close collaboration with local PNGOs to collect data of all beneficiaries and change agents in the field. In January 2018 we launched a data verification call-centre in Max Foundation’s Bangladesh office. The call-centre system enables verification by calling a random sample of registered beneficiaries, which our monitoring staff also cross-check in the field (triangulation). We recently transferred the first of five payments (linked to programme phases through 2021), based on verified results, to our PNGOs. The final payment will be based on achieving the desired health outcome: improved child health, shown through improved growth (height for age, a proxy indicator for measuring stunting reduction). While Max PBR has required an organizational investment, we anticipate pay-offs in increased efficiency, and ultimately impact, and that we’re at the forefront of what could be a new trend in the sector.