Utkrisht Impact Bond
Launch Year: 2018
Instrument(s): Development Impact Bond
Target Geography(s): India
Target Sector(s): Healthcare
Target Financial Size:USD 10 Million
Key Stakeholder(s) + Role(s):
- Investor - UBS Optimus Foundation
- Outcomes Funders - USAID and MSD for Mothers
- Service Providers - Hindustan Latex Family Planning Promotion Trust (HLFPPT) and Population Services International (PSI)
- Outcome Evaluator - Mathematica
- Performance Manager - Palladium
Executive Summary
With more than 70 percent of the population living in rural areas and low level of health facilities, India has one of the highest newborn mortality rates in the world. The maternal mortality rate in Rajasthan is 47 percent above the national average. And an estimated 80,000 babies die every year in Rajasthan.
One of the biggest challenges pregnant women in rural Rajasthan face is access to quality mother and child healthcare. 25 percent of women of all socio-economic backgrounds in Rajasthan choose private facilities for their deliveries. However, private healthcare is costly, and facilities are often unregulated and the quality of care provided varies widely. Improving the quality of care in private facilities is key to reducing maternal and newborn deaths in Rajasthan.
The Utkrisht Development Impact Bond (DIB) was an innovative, successful, outcomes-based funding program to improve quality of maternal and newborn health in the private sector of Rajasthan, India. After three years of implementation, the program improved the quality of maternal and newborn care in 405 small private healthcare facilities throughout Rajasthan, improving the delivery of care to an estimated over 450,000 mothers and newborns. The Utkrisht program judged quality based on two standards, namely, the NABH (National Accreditation Board for Hospitals and Healthcare Providers) and FOGSI (Federation of Obstetric and Gynaecological Societies of India) standards. Consistent with its DIB design, the Utkrisht program also delivered a financial return for both its investor and implementation team, in addition to results above and beyond the baseline target. Final results will be released at UNGA in September 2022.
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Financial Structure
Utkrisht Impact Bond used innovative social financing to draw together several partners for the purpose of improving the quality of maternal and newborn healthcare in private health facilities in Rajasthan, India, with the ultimate goal of reducing maternal and newborn deaths.
Key Insights/Learnings
Lessons Learned | Quality improvement
- A collaborative partner work/governance structure, fostered by the collocation of the implementation team in a Jaipur office created a strong working relationship among the organizations.
- Commitment of the facility leaders was crucial to improving services. The pressure to achieve results encouraged a strong pace of work.
- Digital platforms played a significant role in quality improvement and the commitment of the facilities, especially in the wake of COVID-19.
- The higher-level health impacts (e.g., mortality) of the program intervention cannot be established with certainty. The ultimate impacts are often highly complex, longer term, and influenced by a myriad of factors beyond the scope of a single intervention.
- A change in government administration created a less supportive policy environment. Changes in insurance schemes led to a decrease in births in private facilities.
Lessons Learned | Impact bond mechanism
- A performance management information system, was a critical asset to field implementation planning and performance management by monitoring facility progress and trends to make strategic course corrections.
- High level of adaptive management and continuous course correction allowed the program to flex with the changing circumstances.
- The freedom of the impact bond approach allowed the implementation team to adapt approaches to achieve results as it saw fit and allowed the team to quickly adapt to the unforeseen COVID-19 pandemic.
- Uniting the strength of each partner. Utkrisht's success was built on USAID's understanding of the Indian health system, MSD for Mothers' expertise in quality improvement, UBS Optimus Foundation's experience in structuring and managing impact bonds, as well as Palladium's commitment to effective project governance and performance management.
- Effective performance management. More proactive performance management within the financial parameters could have led to expansion to more facilities, thus further reducing the price per unit of outcome thereby achieving more impact.
Impact to Date
The Utkrisht program was designed to improve the quality of maternal and newborn care provided in small private healthcare facilities in Rajasthan. The program achieved both its quality improvement and financial objectives. It also delivered a financial return for both its investor and implementation team based on the achievement of the below health results.
