Maternal and Newborn Health DIB

An innovative way to reduce maternal and newborn mortality rates in India.

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.


Saving lives is more rewarding than ever

The world’s first development impact bond in healthcare enables clients to put their capital to work and improve maternity care in India.


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.

184

Ranking 184 out of 217 countries, India has one of the highest newborn mortality rates in the world.

47%

The maternal mortality rate in Rajasthan is 47% above the national average.

244

mothers in Rajasthan die per 100,000 live births.

14%

The newborn mortality rate in Rajasthan is 14% above the national average.

47

newborn babies in Rajasthan die per 1,000 live births.

80,000

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."


DIB partners

The Utkrisht DIB is a partnership between, HLFPPT, Palladium, Population Services International, MSD for Mothers, UBS Optimus Foundation, and USAID.



How it works in practice

  1. The implementation manager, Palladium, designs the impact bond and manages the implementation of the program throughout the three-years.
  2. The upfront funder, UBS Optimus Foundation, provides the initial working capital to non-profit organizations PSI and HLFPPT.
  3. With the provided starting capital, PSI and HLFPPT can begin their work with the private facilities in Rajasthan. 
  4. Throughout the three-year program, independent verifier, Mathematica, regularly assesses the progress against pre-determined targets.
  5. 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.


Future outlook

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.


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