The Maternal and Newborn Health development impact bond (DIB), also called Utkrisht Development Impact Bond, is one of the most ambitious impact bonds to date. This innovative social finance tool draws together several partners toward the end goal of reducing maternal and newborn mortality in Rajasthan, India.
The Utkrisht Impact Bond gets its name from the Hindi word for 'excellence' and is pronounced 'UT-KRISH-T'.
A bond for mothers and newborns
The world’s first DIB in mother and child health care will improve the quality of care for up to 600,000 pregnant women in as much as 440 small health care organizations (SHCOs) in Rajasthan.
If successful, this DIB could save up to 10,000 lives over a five-year period. According to WHO standards for cost-effectiveness of saving a life, this is a highly cost effective partnership.1
The UBS Optimus Foundation is the upfront funder, but all implementation partners are also co-investors, sharing in the risks and rewards. The success of the Utkrisht DIB will be judged on whether these health care facilities are ready to achieve the new certification standard, making quality maternal care in private health facilities standardized for the first time. Looking beyond Rajasthan, the program could be replicated and rolled out across the country, contributing to much improved maternal and neonatal care and reducing mother and child deaths significantly.
The problem the Maternal and Newborn Health DIB seeks to address
In India, over the past decade, there has been a significant shift from home births to hospital births, but efforts to improve the quality and consistency of care in hospitals have mainly focused on public providers.
Private facilities – used for over 25 percent of all institutional deliveries by women of all socio-economic backgrounds in Rajasthan – are filling this gap in providing maternal and newborn healthcare.2 But, the quality of healthcare these facilities provide to mothers and babies varies widely. Improving the quality of care in private facilities is key to reducing maternal and newborn deaths in Rajasthan.
Ranking 184 out of 217 countries, India has one of the highest newborn mortality rates in the world.
The maternal mortality rate in Rajasthan is 47% above the national average.
mothers in Rajasthan die per 100,000 live births.
The newborn mortality rate in Rajasthan is 14% above the national average.
newborn babies in Rajasthan die per 1,000 live births.
An estimated 80,000 babies die every year in Rajasthan.
"DIBs will change how implementers think about their work, with the flexibility to focus on outcomes rather than activities."
“The whole DIB model is super new – it’s really exciting. As implementation manager, our role is to support local NGOs in doing their best work by providing them with up-to-the-minute information about whether they’re hitting targets in the best possible way – and if not, helping them figure out why.
Many traditional development programs are based on a pay-and-hope model. The contract sets in stone the activities at the beginning; but if the desired impact is not reached, there is no penalty – service providers still get paid. This is one of the reasons why results-based financing, and then DIBs, came into being.
The DIB is structured so the whole implementation partnership – the providers and ourselves – are co-investors. So, if we don’t hit the targets, we all stand to lose money. And if we do hit them, we’ll all share in the reward. DIBs will change how implementers think about their work, with the flexibility to focus on outcomes rather than activities.
From its experience with the original Educate Girls DIB, the UBS Optimus Foundation brought an invaluable perspective in the development of the Utkrisht impact bond.
In Rajasthan, you have an abundance of health care providers and a high proportion of women giving birth in health care facilities. Yet, there are unusually high levels of maternal and neonatal mortality. So, our laser focus is on improving quality of health care services in the vibrant private health facility sector, toward the ultimate goal of saving the lives of mothers and babies.
The DIB model uses extreme transparency and accountability, with the flexibility to adapt to emerging situations. We’ll minutely examine and analyze the progress of each health care facility, working with the service providers to test hypotheses so that they can constantly fine-tune their approaches. At the end of the three-year period, we’ll know the best possible way to improve the quality of maternity services in private health facilities – for the lowest possible cost.
We want to see a real change in the culture of NGOs to real-time results performance awareness. We want to see improved quality of services in these private health care facilities, inspiring confidence in the government and the public. And we want to get the very best out of every development dollar and see our learnings shared. But central to it all is that we want to see improved outcomes for mothers and babies. That’s why we’re doing it – that’s the be-all and end-all.”
The Utkrisht DIB is a partnership between, HLFPPT, Palladium, Population Services International, MSD for Mothers, UBS Optimus Foundation, and USAID.
A non-profit organization that stands as one of the leading public health organization in India. HLFPPT’s core area of work is RMNCH+A (Reproductive, Maternal, Newborn, Child, and Adolescent Health) with focus on poor and marginalized rural and urban population. It works with a vision of increasing access to quality healthcare products and services. Over the last two decades, HLFPPT has reached out to more than 425 million people across rural and urban India, delivering quality healthcare services at their door steps.
A global leader in the design, development and delivery of positive impact – the intentional creation and measurement of enduring social and economic value. Palladium works with corporations, governments, foundations, investors, communities and civil society to generate lasting social, environmental and financial benefits.
A leading global health organization working in over 50 countries in the areas of family planning and reproductive health, HIV/AIDS, malaria, child survival, non-communicable diseases and sanitation. Partnering with the public sector and harnessing the power of markets, it provides life-saving products, services and communications that empower vulnerable populations to lead healthier lives.
MSD for Mothers is MSD’s global initiative to help create a world where no woman has to die while giving life. MSD for Mothers is committed to testing innovative models that expand women’s access to affordable, quality care with the potential to be scaled and sustained. MSD for Mothers is an initiative of Merck & Co., Inc., Kenilworth, NJ, U.S.A.
The UBS Optimus Foundation connects its clients with inspiring entrepreneurs, new technologies and proven models that are making a measurable, long-term difference to the most serious and enduring social and environmental problems. The only client-facing Foundation linked to a global wealth manager, UBS Optimus Foundation has a long track record and is recognized globally as a philanthropic thought-leader. It takes an evidence-based approach and focuses on programs that have the potential to be transformative, scalable and sustainable. This gives clients the reassurance that they are funding innovative projects that have a stronger chance of achieving all-important systemic change. UBS also makes matching contributions to the Foundation, ensuring clients' donations will go even further.
How it works in practice
- The implementation manager, Palladium, designs the impact bond and manages the implementation of the program throughout the three-years.
- The upfront funder, UBS Optimus Foundation, provides the initial working capital to non-profit organizations PSI and HLFPPT.
- With the provided starting capital, PSI and HLFPPT can begin their work with the private facilities in Rajasthan.
- Throughout the three-year program, independent verifier, Mathematica, regularly assesses the progress against pre-determined targets.
- The outcome payers, USAID and MSD for Mothers, pay the investors back the original amount invested, plus additional returns if predetermined targets are met.
In a usual construct, non-profits don't co-fund the DIB, but they do in this context. In a further innovation, the non-profits, PSI and HLFPPT, are also co-investors. Together with the UBS Optimus Foundation, they contribute up to 20 percent of the capital requirement. All parties will be treated equally, fully aligning the risks and rewards.
Private capital is transforming the way healthcare is provided in India.
The Utkrisht DIB is the first to be launched that uses genuine private capital raised from private investors, raising the bar in terms of a real-world application of something that has previously only been done in laboratory conditions with soft capital. This bond will provide an essential intermediate step as proof of concept for healthcare interventions and outcomes-based contracts throughout India.