NextBillion - An Initiative of the William Davidson Institute at the University of Michigan

Tuesday, April 9, 2019

A newly launched development impact bond (DIB) is funding a health practice that will save and improve hundreds of newborn lives in Cameroon. This ground-breaking USD 2.8 million DIB is the first DIB globally to focus on newborns, the first DIB to focus on maternal and child health in Africa, and whose design has been led by the government of Cameroon.

Every year, 20,000 newborn babies die in Cameroon[i]. Low birth weight (LBW) and prematurity are leading risk factors for neonatal mortality. Kangaroo Mother Care is a proven and globally recommended health practice for babies born early or small, which involves holding the baby skin-to-skin on the mother’s or other caregiver’s chest, ideally feeding them only breastmilk, minimising time in hospital and having close follow-up of the mother and baby once they return home. Research has shown that KMC offers even greater protection against newborn mortality than traditional incubator care^[1].

With the financial support of the Government of Canada, Grand Challenges Canada will provide USD 800,000 dollars in upfront funding to upgrade health facilities and train health practitioners. The Fondation Kangourou Cameroun will use the capital to build critical infrastructure, purchase specialized equipment, and provide professional KMC training for staff and ongoing support in health facilities across Cameroon.

As outcomes are achieved – notably an increase in access to quality KMC and the resulting improvements in weight gain for LBW or premature newborns – the Government of Cameroon via the Ministry of Public Health, with the support of the Global Financing Facility (USD 2 million), and Nutrition International (USD 800,000) as outcomes funders will pay Grand Challenges Canada for each unit of outcomes achieved. If the results achieved are aligned with expectations, Grand Challenges Canada will receive its principal plus interest. Outcome funders only pay the investors when results are achieved—meaning an efficient and effective use of their funding—with the upfront investor potentially getting a good return on investment, doing well by doing good.

The DIB will support government efforts to improve access to KMC in 10 hospitals across the country. Once implemented, this program will provide life-improving care for more than 2,200 newborns by 2021. With support from the Fondation Kangourou Cameroun, centres of excellence will be created in 4 regions. Using a train-the-trainer model, these centres will then build the capacity of other hospitals to promote and implement KMC. This will ensure that the practice of KMC is embedded in the public healthcare system, ensuring sustainability and further scale-up after the DIB.

The Cameroon Ministry of Public Health, Grand Challenges Canada and Nutrition International have led the design of the Cameroon KMC DIB, with support from Social Finance and MaRS Centre for Impact Investing. This DIB is part of the government’s broader results-focused health system strengthening effort, which also includes a national level performance-based financing (PBF) program – where service provider payments are based on their performance – contracting with public and private facilities to deliver essential health services. This PBF program is financed with support from the World Bank and the Global Financing Facility. With these pay-for-performance innovative financing instruments, the Government of Cameroon will be able to deliver results and greater accountability in its health programs across the country.

Statement from the Government of Cameroon:

“To be able to tackle newborn mortality, we need a national approach. Through the Development Impact Bond (DIB), we shall implement KMC in several hospitals thus laying the foundation for it to be scaled across the whole country. The DIB approach ensures accountability which contributes to achievement of set objectives. It’s an exciting way to work towards our goals and build new partnerships along the way.”

Photo courtesy of DFID.