Funding future health through an outcomes-based model for adolescent sexual and reproductive health in South Africa

Adolescent girls and young women in South Africa continue to face disproportionate risks regarding HIV and sexual and reproductive health. Traditional funding models for these services often focus on inputs rather than measurable health outcomes, which can lead to inefficiencies in service delivery. There is a persistent gap in financing for integrated adolescent health programmes, particularly in high-burden districts where the need for innovative, results-based approaches is most urgent.

We collaborated with Tiko and UNFPA to assess the feasibility of a social outcomes-based funding platform dedicated to adolescent sexual and reproductive health. Our work focused on shifting the financial focus from activities to impact. We reviewed existing programmatic gaps and mapped the stakeholder landscape to understand how an innovative financing ecosystem could function within the South African public health context. This involved testing government receptiveness to pay-for-performance instruments and identifying the specific resource requirements for a platform operating across multiple districts.

We undertook a detailed analysis that leveraged insights from existing initiatives, such as the Imagine Social Impact Bond, alongside global best practices. Our approach included an ecological analysis of high-burden areas to ensure that the proposed funding model targeted the most vulnerable populations effectively. 

We developed various options for institutional arrangements, investment finance mixes and performance metrics to guide the platform’s structure. A central part of our contribution was the design of a district-level costing model, which provided a clear financial roadmap for implementation.

The evidence we produced has contributed directly to the project’s theory of change and provided a robust framework for resource mobilisation. By defining the technical and financial parameters for the fund, we enabled our partners to present a credible case for investment to potential donors and government departments. 

This model offers a sustainable pathway to scale up essential health services, ensuring that every Rand spent is tied to a tangible improvement in the lives of adolescent girls.

Landscaping, design and costing for a proposed adolescent health outcomes fund in South Africa

Genesis Analytics was contracted by Tiko with funding from UNFPA to assess the potential for a Social Outcomes-Based Funding platform for adolescent sexual and reproductive health (ASRH) in South Africa. 

The work undertaken included reviewing programmatic and financing gaps in providing HIV and SRH services to adolescents and young women, stakeholder mapping, defining the innovative financing ecosystem and assessing government receptiveness to supporting innovative financing instruments, and estimating the resource needs for a outcomes-based funding platform operating in multiple high burden districts.  

The research and analysis leveraged insights from the flagship Imagine Social Impact Bond as well as other use cases in South Africa and globally, and synthesised global evidence and best practice from successful outcomes-based platforms. 

The project presented various options for institutional arrangements and mix of investment finance as well as pay-for-performance metrics for consideration and contributed to the project’s theory of change. Genesis developed a district-level costing model for the implementation of the outcomes fund, which will be used for resource mobilisation for the proposed funding platform.