Project: Outcomes Fund for Physical Rehabilitation in Pakistan
State of development: Current
Stage of development: Early stage
Stage notes: Early-stage design.
Type of instrument — Impact Bond: No; Outcomes Fund: Yes; Social Impact Incentives (SIINC): No; Social Impact Guarantee: No; Payment-by-results (no pre-financing): Yes; Technical Assistance and Market-building program: No; Other: 
Part of a larger outcomes-based financing program: No 
Expected launch date: Q2 - 2023
Total expected project development time: 12-24 months
Expected length of project (years): TBD
Project design process began: Q3-2021
Rationale for using outcome-based finance: The Outcomes Fund approach would facilitate building a data-driven business case during the term of the Outcome Fund that would serve to prove the economic benefit for government to expand healthcare coverage to PR services. This would also help build an evidence base about the cost of delivering quality PR services to different geographies and demographics.
Key challenges to launch: The intervention is currently in the concept development phase, where the stakeholders are currently being engaged to convene on the model, mandate, and focus. Engaging the government on committing to expand the health insurance scheme will prove challenging. 
Role of the domestic government — Outcomes funder: No; Service provider: Yes; Member of project committee: No; No formal role: No; Other: 
Service providers identified and selected — Request-for-proposals: No; Direct contracting by outcome funder/investor/intermediary: Yes; Provider-led deal development: No; Other: 
Feasibility study: Yes
Proposed financing instruments — Debt: Yes; Equity: No; Guarantee: No; Grant: Yes; Other: 
Technical assistance grant: No — 
Estimated maximum potential outcome payment: TBD TBD
Social/developmental challenge: With a population of 220 million, there are currently more than 1.1 million people in need of mobility-focused assistive devices. There is significant demand, while the current infrastructure of the physical rehabilitation services is unable to meet this growing demand. In addition, most physical rehabilitation services are not covered by the healthcare insurance scheme, resulting in significant out of pocket expenses by patients.. The intervention seeks to address two key challenges: 1) Ensuring the sustainability of the provision of high-quality physical rehabilitation services, without requiring continued support from the ICRC and 2) Increasing government engagement to ensure sufficient coverage of physical rehabilitation services within the national health insurance scheme.
Expected intervention model: The end goal is for the government to expand the package of covered services within the national health insurance scheme. This would be achieved through building a data-driven business case during the term of the intervention that would serve to prove the economic and social benefit for the government to expand healthcare coverage to physical rehabilitation services. This would also help build an evidence base about the cost of delivering quality physical rehabilitation services to different geographies and demographics. The intervention envisions to pay physical rehabilitation service providers based on outcomes linked to quality of service delivery and reimburse the national health insurance scheme for the additional services included. 
Policy sectors — Employment and private sector development: No; Education: No; Social protection: No; Criminal justice: No; Health: Yes; Agriculture: No; Environment and climate change: No; Water, Sanitation and Hygiene: No; Energy: No; Humanitarian: No; Early Childhood Education: ; Other: 
Secondary SDG goals: 3,17
Target population: People with disabilities needing mobility-focused assistive devices. 
Targeted number of unique service users or beneficiaries: TBD
Unit type of targeted beneficiaries: Individual
Country income classification of beneficiaries — Low-income: No; Lower-middle-income: Yes; Upper-middle-income: No; High-income: No
Notes: Data for this pipeline project was last updated in April 2022. 
Delivery location: Pakistan