The value in undertaking an outcome-based financing (OBF) model in Addis Ababa and Bahir Dar has been tangible for us at Triggerise. The clear parameters allowed our team to focus on their goals both single-mindedly and as a unit. ‘Everyone pitched in and brought what they had; we had so many activations to reach the young girls. Nobody was idle, we all contributed our experience to do what we had to do,’ says Haddis Tadesse, the Field Operations Lead in Ethiopia.
‘There is more momentum than ever to identify creative solutions such as [OBF] for children and vulnerable populations around the world.’ As an organisation, we seek out ways to streamline and improve the quality and efficiency of our programmatic interventions, and OBF signals a move towards the type of smart impact that we pursue.
Adopting outcome-based financing
The development sector’s use of OBF payment models (where a funder makes payments contingent on the achievement of pre-agreed outcomes) utilises innovative financing models to improve social outcomes for vulnerable populations. Once targets are established, project implementers are able to allocate resources in the most effective manner to meet them.
The focus of our ongoing three-year project is centred on increasing the uptake of sexual and reproductive health (SRH) services and products among adolescent girls and young women (AGYW) aged 15 to 24 in Addis Ababa and Bahir Dar. The Embassy of the Kingdom of the Netherlands (EKN) is our funding partner in this OBF programme, and our payment metric is tied to the total number of SRH services accessed by AGYW, as well as other related monitoring targets. To receive the funding, a minimum of 90% of the payment metric must be achieved within each annual cycle.
Early challenges, strategic improvements, and unprecedented success
The initial stages of this programme were challenging. For approximately six months, due to debilitating national telecom network issues in Ethiopia and other operational difficulties, we experienced significant delays in reaching our targets. From February 2022 however, we restructured our approach based on our experience of what worked in Kenya – our flagship programme – benefitting from being a global organisation and drawing on the strengths of a wider strategy. It took several months for the changes to bear fruit, and from July 2022, these and other operational improvements signalled a decisive and ongoing shift in this programme’s trajectory. Over the course of the year thereafter, we over-achieved on several targets – specifically around unique users and services accessed. Against a target of 70,000; 80,287 SRH services were accessed (115%); and against a target of 54,000; 61,735 unique users enrolled (114%).
Championing the OBF model: feedback from our ecosystems
The OBF contract for 2022 promoted cross-team cooperation, communication, and assisted the team in prioritising their targets. Mekdes Hailu, an Ecosystem Trainer, says, ‘Reaching towards a common objective, we developed a strong team spirit. The OBF helped me track my activities towards results and, in working with different teams, I increased my knowledge of various aspects of our operations.’
It was this cohesion and clarity that led the team to over-achieve on these targets. Through the streamlined approach to implementation, the team on the ground garnered invaluable experience about what it takes to transform a programme’s performance in pursuit of a common goal. The focused outcomes of the OBF encouraged the team to pull together and create more consistent support and access to SRH care for the adolescents in the target groups around Bahir Dar and Addis Ababa. ‘At first it was stressful,’ says Kidist Zinabu, an Ecosystem Launcher, ‘but because of the OBF targets we recalibrated our approach to become more strategic. It all felt worth it; the team passed through a difficult time and we’re now in a more stable place.’
Ultimately, the introduction of an OBF model into this programme elicited a favourable response from the team that was evidenced by their cohesion as well as the impressive results achieved in a relatively short space of time. As a group, they developed more strategic and future-oriented thinking that increased the level of confidence among the team that will serve them well in further implementation.
Perspective from the Tiko network of providers
In the participating clinics and facilities, the effect of Tiko’s presence was tangible. ‘Tiko is essential for our Youth Centre,’ says Jimma Abdissa. He is a nurse and HIV & AIDS prevention officer at the Woreda 6 Youth Centre in Addis Ababa, and has been a Tiko provider for nearly three years. ‘The programme is good because it encourages people, especially youths, to use family planning and other services,’ says Jimma, ‘they are getting much value from Tiko.’ The platform’s benefits for providers and youth in Ethiopia are not limited to service provision: ‘Tiko technology is easy for me to use, so I can work well. The technology is advanced and helpful,’ says Jimma.
Desta Abay, a nurse in Bahir Dar at the Family Guidance Association of Ethiopia clinic, was also impressed by the ease of using the Tiko platform. ‘The difference Tiko has with other health services is, it is tech-based and has no bulky paperwork to do during service provision,’ she says. ‘For me, the technology is very simple and I interact well with it. It is fascinating and makes our work easier.’
Dr Taye from Tabor Medium Clinic and Dr Mehiret from El-bethel Medium Clinic serve youth in their communities with SRH services. Both have been Tiko providers for less than a year, but the benefits of using the platform are evident for the doctors. ‘The Tiko programme is good for youth from low socioeconomic backgrounds needing contraception. It motivates and encourages them to follow up with family planning services,’ says Dr Taye. This observation is echoed by Dr Mehiret: ‘I think young people benefit from Tiko because the platform covers all the costs of a service and confidentiality is a priority.’
We are grateful to EKN for their support thus far and the decision to move towards implementing an OBF model together. We appreciate their willingness to trust us in trying new approaches. For the remaining period of this programme, we are confident that dedicated collaboration will result in continued impact.