The Initial Prize in the Salud Mesoamerica Initiative Results-Based Aid Initiative

The Salud Mesoamerica Initiative is a public-private partnership that provides funding to national governments in Mesoamerica (the region consisting of southern Mexico and Central America) that is conditional on attaining health results in their poorest municipalities. SMI has set into motion a dynamic process that is strengthening health systems for reproductive, maternal, neonatal and child health. The complementary and mutually reinforcing factors driving these changes include: reputational and financial incentives; competition among the participating countries; learning across national boundaries; external monitoring and the use of credible data to measure and reward results; technical assistance; and a sense of urgency created by the imposition of clear, time-bound performance goals. This results-based focus at the population level has also triggered changes in health systems that include: government commitment; strengthened leadership and operational management practices; enhanced coordination and collaboration between teams within the national ministries of health and between national and local levels in the health sector; new policies and norms focused on reproductive, maternal, neonatal and child health; health information data collection and analysis for decision-making and accountability; strengthened commodity management systems; increased demand for health services at community levels; and enhanced service delivery readiness. These system-strengthening measures are providing the foundation for the eight Mesoamerican countries to improve maternal and child health results among the poorest in the subsequent phases of SMI, when improved health outcomes will be rewarded. This results-based aid initiative contains unique features that offer lessons to strengthen other results-based aid initiatives and inform future donor partnerships with countries or between national and subnational governments.