In recent decades, new funding methodologies have been developed with the objective of increasing support for health programs, overcoming the lack of traditional funding mechanisms. Among these is the Result Based Financing (RBF), a financing mechanism that aims to improve the quality of donations by binding the disbursement of funds to the achievement and audit of predetermined results.

The conference, which was held last October 29 in the Auditorium of University of Naples Federico II, organized in collaboration with the Corti Foundation and the Ambrosoli Foundation, was an opportunity to present the results of the study promoted in collaboration with the University on the effectiveness of the RBF project funded by the Italian Agency for Development Cooperation (AICS) and Cariplo Foundation.[/vc_column_text][/vc_column][/vc_row][vc_row type="in_container" full_screen_row_position="middle" column_margin="default" column_direction="default" column_direction_tablet="default" column_direction_phone="default" scene_position="center" text_color="dark" text_align="left" row_border_radius="none" row_border_radius_applies="bg" overlay_strength="0.3" gradient_direction="left_to_right" shape_divider_position="bottom" bg_image_animation="none"][vc_column column_padding="no-extra-padding" column_padding_tablet="inherit" column_padding_phone="inherit" column_padding_position="all" column_element_spacing="default" background_color_opacity="1" background_hover_color_opacity="1" column_shadow="none" column_border_radius="none" column_link_target="_self" gradient_direction="left_to_right" overlay_strength="0.3" width="1/1" tablet_width_inherit="default" tablet_text_alignment="default" phone_text_alignment="default" bg_image_animation="none" border_type="simple" column_border_width="none" column_border_style="solid"][nectar_btn size="medium" button_style="regular" button_color_2="Accent-Color" icon_family="none" text="CLICK HERE TO READ THE RESULTS" url="https://www.fondazioneambrosoli.it/wp-content/uploads/2021/11/STUDIO-CORTI-2021-Results-Based-financing.pdf"][/vc_column][/vc_row][vc_row type="in_container" full_screen_row_position="middle" column_margin="default" column_direction="default" column_direction_tablet="default" column_direction_phone="default" scene_position="center" text_color="dark" text_align="left" row_border_radius="none" row_border_radius_applies="bg" overlay_strength="0.3" gradient_direction="left_to_right" shape_divider_position="bottom" bg_image_animation="none"][vc_column column_padding="no-extra-padding" column_padding_tablet="inherit" column_padding_phone="inherit" column_padding_position="all" column_element_spacing="default" background_color_opacity="1" background_hover_color_opacity="1" column_shadow="none" column_border_radius="none" column_link_target="_self" gradient_direction="left_to_right" overlay_strength="0.3" width="1/1" tablet_width_inherit="default" tablet_text_alignment="default" phone_text_alignment="default" bg_image_animation="none" border_type="simple" column_border_width="none" column_border_style="solid"][vc_column_text]A moment to reflect, thanks to the intervention of authoritative guests, and bring attention to one of the most important methods of supporting global health. At the same table the representatives of the two Foundations, experts in development and global cooperation of international standing such as Nicoletta Dentico of the Society of International Development and Eduardo Missoni of Bocconi University. AICS speakers Mariangela Pantaleo and Andrea Stroppiana took part; James Mwaka, representative of the Ugandan Ministry of Health, underlined how Uganda believes in this financing system and in collaboration with public and private entities of international importance.

The RBF has been found to be the driving force of change for pediatric services, considering that 50,000 children are welcomed and treated every year at Lacor, thanks to one of the largest pediatric wards in Northern Uganda, while Dr. Ambrosoli Memorial represents a life-saving stronghold in a district where 37% of the population is under the age of 10.

St. Mary's Lacor Hospital (Gulu) and Corti Foundation have designed a privately funded RBF system primarily based on quarterly external audits of quality standards. Initially developed to finance outpatient activities, the RBF system was extended to the pediatric wards of Lacor Hospital and introduced for the first time at Dr. Ambrosoli Memorial Hospital in Kalongo in the pediatric ward. After 3 years, this methodology has shown great potential for improving the quality of hospital services.

 “The RBF system consists of a support given to a structure according to the quantity and quality of the results it achieves. More than half of the support projects in developing Countries do not reach the predetermined objectives and do not transform the local reality. Evaluating the quality of the services offered is a real revolution "- says Professor Luigi Greco, Professor of Pediatrics at the Faculty of Medicine of University of Naples Federico II and Associate Dean of the Faculty of Medicine of the University of Gulu which contributed to found, head of Federico II's GULUNAP project and cooperation projects with Uganda - “We compared the quality of care for children of two big hospitals in Northern Uganda, St. Mary's Lacor Hospital and Dr. Ambrosoli Memorial Hospital, performing a quarterly supervision. In light of these results, we have verified that the project has produced for the first time a significant improvement of 30-40% in the quality of care in these big hospitals ".

The analysis of the data starting from the medical records and RBF check-lists sent by the two Ugandan hospitals was carried out by the team headed by Professor Sergio Beraldo of the Department of Economics and Statistics of the University of Naples Federico II: "The examination of patient records showed that the quality of medical care improved, mortality in children, reinfection rates and hospital stay time decreased ",

The RBF method consists in assigning a fixed amount, equal to about 15 Euros, for each pediatric hospitalization. This figure includes the investigations and therapies needed by the child, regardless of the length of hospitalization and the type of illness. To this is added a quality bonus which is attributed based on the score achieved by verifying the quality of the services quarterly. The score ranges from one to five and allows you to increase the amount paid to the hospital from 5 to 25 percent, thus attributing a financial bonus to the hospital. (note to Laura: I deleted this part because Corti and us, we use the bonus differently and it would take too long to go into detail on the different ways of managing the bonus)

Both at Lacor and at Dr Ambrosoli Memorial Hospital quality and quantity indicators have been developed: it is a very detailed list with parameters monitored every three months by members of an internal quality committee and by a representative of the Ugandan Ministry of Health.

An approach that has managed to aggregate private and institutional donors thanks to the security it offers and the regular and frequent monitoring that allows the donor to follow the project step by step, with its successes and challenges. The Italian Agency for Development Cooperation, which, since April 2018, has financed the initiative with a total amount of 750 thousand euros, believes it to the end.

"At Lacor Hospital there have been structural improvements and increased attention to infection prevention, the availability of drugs, the preparation of all personnel for emergencies and the development of protocols for clinical and nursing procedures - said the Dr. Venice Omona, specialist in pediatrics and head of the pediatric ward of Lacor - “The sense of responsibility of the staff with respect to the resources of the ward has improved; they are all more attentive to every step that concerns the care of little patients. We have developed new protocols and the challenge is to be able to follow them in the best possible way. The dialogue between the staff and with the parents of the young patients was also at the center of the work and I noticed improvements in the ability to explain diagnoses, necessary investigations and therapy "

Even in Kalongo, where the RBF methodology with quality checks was introduced for the first time with the project funded by AICS, the program has produced a truly remarkable impact, as shown by the data developed by Professor Greco in the examination of medical records.

 “The clinical management of pediatric patients has improved significantly since 2016, most notably in Kalongo. Observe for example the increase in variations from 2016 to 2020 to evaluate the marked changes that have occurred: the compilation of a detailed clinical history and the accuracy of the child's examination have improved by more than 6 times (= 600%). Likewise, good sepsis treatment has increased 9 times, ” underlines Professor Greco.

Dr. Godfrey Smart Okot, director of Dr. Ambrosoli Memorial Hopistal, confirms the evidence found through the examination of medical records: "Before the start of the project, three years ago, the clinical and ethical practice regarding the care of the sick child in the hospital was more rooted in the routine. Subsequently, the approach evolved. More emphasis is now placed on studying the sick child, communicating eloquently with the child's caregiver, and ensuring that the treatment environment is sufficiently holistic (clean, safe and calm). The preparation of the project actively involved the staff, through training on 'best practices' and the related advantages. The staff therefore realized how much this method not only guarantees that the sick child heals, but also affects positively their professional skills. The final result is that the overall quality of care has improved significantly compared to the period before the project ”.

This result is even more significant if we consider the stress to which the Kalongo hospital and the pediatric ward were subjected for the always lurking epidemics: between 2019-2020 due to malaria, total hospitalizations increased of 83% compared to the same period the previous year,  the bed occupancy rate of 198%. This means that for months the hospitalized children exceeded the availability of beds in the ward and the staff was forced to accommodate more patients in one bed or use improvised spaces for hospitalization. Then followed the long period marked by the pandemic, where all the ward staff remained always operational and ready to welcome the numerous patients, despite the fear of contagion.

“The RBF method is a tool that helps to maintain a surveillance and control system on the quality of services”, emphasizes Professor Greco. “It is a model that helps to avoid waste”. Many, therefore, have been the successes and many more challenges. “The greatest is that the changes induced by this three-year project become everyday life”, concludes Luigi Greco

We thank the University Service Center for the Coordination of Special Projects and Organizational Innovation (COINOR) and the support of Federico II Department of Economics and Statistics.[/vc_column_text][/vc_column][/vc_row]

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The St. Mary's Hospital in Lacor (Gulu, Uganda) and the Corti Foundation, after a first experience with the RBF approach funded by the British government, have extended the adoption of incentive mechanisms of this kind with the aim of improving the quality of healthcare provided.

Thanks to the three-year contribution of the Italian Agency for Development Cooperation (AICS), results-based financing mechanisms have been tested in the pediatric wards of Lacor Hospital and Dr Ambrosoli Memorial Kalongo Hospital, showing considerable potential in improving the quality of the services provided, hence in contributing to the reduction of the high infant mortality rates.

Starting from this experience, and from the analysis of the evidence gathered in the hospitals of Lacor and Kalongo, the University of Naples Federico II, in partnership with the Corti and the Ambrosoli Foundation, promotes a conference on result-based financing programmes with the aim of discussing their effectiveness in favouring sustainability and quality in the health sector.

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"Father Giuseppe Ambrosoli is perhaps the most significant example of the friendship between Italy and Uganda. A man who dedicated himself with enormous generosity to the Acholi people, "his people", to the point of giving his life. Even today, more than thirty years after his death, his memory is well alive in Uganda, both in the local communities and among the Italian community.

The book "Call me Giuseppe" is a beautiful story of humanity, a journey through the life of this extraordinary man and a reflection on the legacy he left us". These are the words with which H.E. the Italian Ambassador in Uganda  Domenico Fornara opened the event.

In the wonderful setting of His residence, the Italian Ambassador H.E. Fornara, the President of the Ambrosoli Foundation Giovanna Ambrosoli, the Director of Kalongo Hospital Dr. Godfrey Smart Okot and the Director of the midwifery school Sr. Carmel, intervened many illustrious guests to remember Father Giuseppe and particularly what he did in this land. Among them, the Minister for Refugees Hon. Hilary Onek and Monsignor Matthew Odong General Vicar of the Archdiocese of Gulu.

During the presentation the guests shared many personal life and spiritual experiences, heritage of Father Giuseppe’s teaching and memory. Those who had the privilege of meeting Father Giuseppe in Uganda recalled his figure to a large public, among which the German Ambassador, the Spanish honorary Consul, , the former Undersecretary of the Ministry of Foreign Affairs and International Cooperation Sen. Alfredo Mantica and the Italian soccer players Simone Perrotta and Damiano Tommasi, along with many other friends of Kalongo.

Special thanks to the Ambassador, who has always supported Dr Ambrosoli Hospital in Kalongo and believed in the daily commitment of the Foundation. Through this initiative he wanted to pay tribute to Father Giuseppe in Uganda, in the country he loved so much and to which he has dedicated his life.

Here are some of the testimonies of the guests who took part in event:

“Father Ambrosoli is a gift of God for the Acholi people: he has touched so many lives, not only in Kalongo, but throughout northern Uganda, he has left a mark and if there is anyone to be canonized it should be him. I remember that in 1967 during a vacation I caught pneumonia, with a strong pain that tore my chest, so I was advised to go to Father Ambrosoli. When I arrived he touched my head, started to pray for me, he gave me some medicine and said, "You'll be fine." I immediately felt a very cold sensation going through my body, the pain disappeared and never came back. I am honoured to be here today to celebrate a tribute to Father Giuseppe”.

Hon. Hilary Onek, Minister for Refugees in Uganda

"The midwifery school is truly the great legacy that Father Giuseppe left us. I call him "the miracle maker" because in the difficult and terrible moment of the war many students from other schools fell into ambushes, ours were all saved and this was a real miracle for us. Father Giuseppe was an excellent tutor because every time he could teach the students and dedicate himself to them, they passed the exams and fulfilled their future of hope. But he was also a great visionary, he always said "if I do not start and I do not pursue the midwifery school, my work cannot continue. It is precisely these young women who will continue my project for this country." Today, St Mary’s school has contributed to the growth of 3 midwifery schools in Matany, Kitgum and Lacor: here all the tutors come from our school in Kalongo. This is the dream of Father Giuseppe that has come true "

Sr Carmel Abwot, Director of St Mary’s Midwifery School in Kalongo

"The name of Father Giuseppe is perhaps better known in the Acholi region than in Italy. At that time many people here did not trust doctors but he managed to gain their trust. Some patients who had been visited by other doctors hid the prescriptions of the previous doctors to queue again and have the attention of Father Giuseppe. I too was a "victim" of this system: when my illness did not improve, I thought "well I will have to do so too, to be received by him!". If today I am a priest it is thanks to the prayer of Father Ambrosoli. He was a gift for the Acholi people and for all Uganda"

Monsignor Matthew Odong General Vicar of  the Archdiocese of Gulu

To book a copy of the book, please contact info@fondazioneambrosoli.it

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