It has been inspiring to see the international community embrace the United Nations’ Sustainable Development Goals (SDG). Even more encouraging are the growing recognition of the critical role the private sector has to play, and the push for meaningful public-private partnerships (PPPs), in order to reach these goals.
One of the biggest challenges will be figuring out how to pay for all the hard work that lies ahead. The UN has estimated an annual shortfall of some $2.5 trillion in terms of what it will take to achieve the SDG in developing countries. To close this funding gap, we will need PPPs to be bold and innovative. We will need to find ways to tap new sources of financing. And we will have to make sure we are leveraging those resources for maximum impact. Traditional approaches are not going to cut it.
One such pioneering approach is the development impact bond (DIB), a new kind of funding contract used to support social initiatives in low-resource contexts. As a form of impact investing – an emerging area that is gaining in popularity, but which is largely untested in the field of public health – the DIB offers a promising new way to mobilise private capital.
It has some other unique advantages, too. Most importantly, like other forms of results-based financing, the DIB model upends the classic development paradigm by allowing traditional donor-stakeholders to finance actual results rather than ideas. With a DIB, funds from private investors cover the initial costs of implementing a programme; this takes the pressure off cash-strapped governments, public sector agencies and NGOs. Only when specific, measurable programme goals are met are upfront investors reimbursed in full - plus a modest premium as a return on their investment - by outcome funders. Traditional donor-stakeholders only pay for results. This drastically lowers their financial risk, while also helping to satisfy growing demand among private investors who may be more comfortable experimenting with new models, and who are looking for opportunities to invest ethically.
Another advantage to the DIB is that performance incentives are built right into the contract. By shifting focus from methods to outcomes, implementers - guided by real-time data - have the flexibility to learn from failure and shift course if something’s not working. And those outcomes are more likely to translate into future healthcare savings.
Last month, MSD for Mothers, together with the U.S. Agency for International Development, UBS Optimus Foundation, Palladium and other partners, announced the Utkrisht Development Impact Bond. It is the world’s first DIB in global health, though there are others in the works. Named for the Hindi expression meaning excellence, the Utkrisht bond will support efforts to improve the quality of maternal health care in India’s Rajasthan state, an area with an exceptionally high rate of preventable maternal and newborn deaths.
Improving the quality of care that mothers receive during pregnancy and childbirth is one of the most effective ways to reduce maternal and neonatal mortality, the chief aims of SDG 3. With the funding provided through the Utkrisht bond, our implementing partners – Population Services International (PSI) and Hindustan Latex Family Planning Promotion Trust (HLFPPT) – will work with healthcare providers at 440 private clinics to improve skills and capacities in critical areas. The programme’s success depends on these facilities achieving national accreditation, based on their compliance with Indian national clinical standards. By focusing on the quality of service provided by private facilities, the programme complements government efforts to upskill public equivalents. About a third of women in Rajasthan who seek facility care – women who come from all income levels – access it through private facilities, where the quality of service can vary considerably.
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An estimated 600,000 women stand to benefit from the initiative. It could potentially save as many as 10,000 lives. What’s more, once the programme’s goals are met, the government of Rajasthan will consider expanding the program.
This arrangement represents the kind of innovative public-private partnership and creative use of resources needed to cross that 2030 finish line – not just in health, but in hunger, poverty, climate change and every other global goal. As USAID’s co-outcome funder, MSD for Mothers is keen to share insights from this first foray. USAID has already indicated that should the Utkrisht bond succeed, it would look to expand the model across other initiatives.
It took many months to get our DIB off the ground. It wasn’t easy negotiating a new type of contract with so many partners. We are in uncharted territory. But it’s exciting to be at the start of something big, and bold. We look forward to sharing our learning to help pave the way for more innovative partnerships, more deals that unleash capital and carry us closer to our shared goals, and our shared vision of a world that is safer and healthier for mothers.