Overall, the activities divided into three tranches aimed to produce new evidence about improving efficiency and effectiveness of HIV prevention through combining it with reproductive health services and delivering it as RBF/OBA. The evaluation was organized around three questions:

(1) efficiency of combining and funding as RBF/OBA,

(2) modeled impact of averted HIV and its consequences, and,

(3) modeled impact of averted unplanned pregnancies and their consequences.

This Tranche 1 supported the development of methodology and evaluation design for statistical modeling of averted HIV cases. The models could be used worldwide and were to be tested in Zimbabwe.

This activity supports the transfer of OBA knowledge during implementation of Zimbabwe Health RBF IDA operation ($45 million, budget increased from the initial $35 million). The key deliverables for this TA component are: voucher pricing, verification protocols and MIS, quality of care guidelines and checklists, and lessons/technical review report.

In this reporting period, a review mission was undertaken by the World Bank and it confirmed that the electronic system used to manage beneficiary data and claims processing was functioning optimally. While this activity is closed, the Zimbabwe Health RBF financing operation has been extended to June 30, 2018. 

Overall, the activities divided into three tranches aim to produce new evidence about improving efficiency and effectiveness of HIV prevention through combining it with reproductive health services and delivering it as RBF/OBA. The evaluation is organized around three questions: (1) efficiency of combining and funding as RBF/OBA, (2) modeled impact of averted HIV and its consequences, and (3) modeled impact of averted unplanned pregnancies and their consequences.  This Tranche 2 supports baseline data collection and models the effectiveness of HIV and reproductive health services (with RBF as a delivery mode).

The deliverables under tranche 2 have been completed. Most disbursements took place in the prior reporting periods, following the methodology developed under Tranches 1 that closed in August 2017. In turn, the deliverables under Tranche 2 served as a basis for activities under Tranche 3 that is reported below. 

The objective of the overall program of support for HIV efficiency, effectiveness, integration, incentives and sustainability, jointly agreed between DFID and the World Bank (detailed in the Concept Note) is to:

a) Bring new evidence about how to improve the efficiency, effectiveness and integration of various HIV programmes

b) Determine how incentives could be used to strengthen HIV programmes’ impact and implementation

c) Support governments to implement such changes at country level

d) Strengthen efforts to make the economic case for why these HIV investments yield good returns

The successful completion of these activities will contribute to the attainment of the higher-level objectives of the overall program described above.

This activity helps produce new evidence on improving efficiency and effectiveness of HIV prevention through combining it with reproductive health services and delivering it as RBF. Tranche 1 (of 3) supports the development of methodology and evaluation design for statistical modeling of averted HIV cases. The models can be used worldwide and will be tested in Zimbabwe.

The reports have been presented to the stakeholders for feedback as well as at the AIDS 2018 conference in Amsterdam in July 2018.  The evaluation concludes that (a) the administration of the HIV and reproductive care as combined leads to better patient outcome, as evidenced by 90,000 transmissions averted including 12,000 mother-to-child transmissions in 2011-2015 and (b) that hospital patients who receive the HIV and reproductive care as combined were more satisfied, while the patients in primary care centers and out-patient departments did not show an increase in satisfaction.  The activities supported in Tranche 3 were built on the methodological work supported under Tranche 1 and the baseline surveys supported by Tranche 2.