Aceso Global has been working with the Inter-American Development Bank (IDB) on the Salud Mesoamérica Initiative (SMI). SMI is a pioneering public-private partnership between the Bill & Melinda Gates Foundation, the Carlos Slim Foundation, the Government of Spain, the IDB, the countries of Central America, and the state of Chiapas, Mexico. It is one of the most successful and thoughtfully designed results-based aid (RBA) models and we are excited to join and contribute to their effort, while also learning from their work.
SMI aims to reduce maternal and child health inequalities through an RBA model that is in alignment with the priorities established by the governments of the region. The SMI model is based on four basic concepts[1]:
1. Countries have to work within the poorest 20% of their populations, selected based on Poverty Incidence Data;
2. SMI funds can only finance evidence-based, cost-effective and promissory interventions for maternal and child health;
3. All projects are co-financed by SMI and countries (50% average cost-sharing) and must be executed using the SMI results based aid model; and
4. All results are externally verified by an independent third party through both household and health facility surveys. If countries meet 80% of their goals, they receive 50% of their original investment to use freely within the health sector.
Specifically, Aceso Global is tasked with designing an innovative learning program for middle managers to support Quality Improvement (QI) efforts in the eight SMI countries. The program breaks from more traditional training styles that use didactic lecturing and aims to reach behavior change and competency development with interactive and experiential learning techniques. The curriculum focuses not only on the “hard skills” of measuring and improving quality of care, but also on “soft skills” like leadership, team building, communication, coaching and continuous learning that are essential ingredients for any change process. It is firmly grounded in the local realities of the SMI countries and uses case studies, experiential learning and peer-to-peer exchanges to convey contents over the course of the ten-month training.
The competency development program equips middle managers with the necessary skills to coach frontline primary healthcare providers on QI. It also contributes to the larger transformation agenda that SMI and country leaders are pursuing to fundamentally shift the way that care is delivered, to put quality at the center of organizational culture, and to move towards a true learning system that accepts failure and is relentless in the pursuit of innovation and improved performance.
Aceso Global is also developing a unique evaluation strategy for the learning program that examines changes in leadership, organizational culture and skill development, deploying customized evaluation instruments that will gauge the extent to which hard and soft skills have been mastered. The purpose is to yield standardized, comparable data on leadership behaviors and organizational contexts that influence the successful implementation of QI initiatives and ultimately lead to improvements in maternal and child health.
This project falls under Aceso Global’s quality portfolio, which addresses quality of care across the health system by: (1) collaborating with country leaders to put quality of care culture, measurement, improvement and innovation at the center of national healthcare agendas; (2) working closely with providers and stakeholders on the frontlines to shift the culture around quality of care and improve the use of quality data; and (3) integrating quality data with national health information systems, including supporting or developing quality dashboards. Our portfolio approach echoes some of the key takeaways from last year’s wave of reporting on global quality of care, including the Lancet Commission’s High-quality health systems in the Sustainable Development Goals era: time for a revolution, the OECD, World Bank and WHO report, Delivering Quality Health Services: A Global Imperative for Universal Health Coverage, and finally the Institute of Medicine’s Crossing the Global Quality Chasm, for which Aceso Global CEO and Founding Director Maureen Lewis was an expert reviewer.
For more information, please contact: Sarah Mintz, smintz@acesoglobal.org
[1] Salud Mesoamerica Initiative Program Description, Progress and Results, May 2016