The year has started with a number of key meetings and breakthroughs with regards to the ongoing design of the Impact Bond Innovation Fund. We held our 3rd steering committee meeting at the Public Policy Unit in Dorp Street this week and generated a fruitful discussion amongst the Departments of Health (DOH) and Social Development (DSD) representatives attending the process.

As you may recall, by the end of the last year the focus of our enquiry narrowed from looking at the entire spectrum of early childhood development (0-9 years) to looking at the first 1000 days (conception to 2 years). This decision was taken as a result of intensified government interest in the cohort especially in the form of home and community based service provision, the measurability of outcomes and the cost benefit associated with early intervention.

We have spent the last 3 months accessing and analysing the raw data from large government datasets in order to map the current levels of deprivation versus provision and outcomes as well as starting to generate baselines for potential outcomes. Those datasets include the District Health Information System, the Perinatal Problem Identification Programme (PPIP), the Child Problem Identification Programme (CHIP), the DSD register of Early Childhood Development facilities, the DSD Socio-economic Index, the Child Support Grant register, the South African National Health and Nutrition Examination Survey (SANHANES), the 2001 Census and the Centralised Education Management Information System. The Western Cape Province keeps some of the most comprehensive records in the country but each of these datasets has significant weaknesses that will influence the quality of analysis.

We organized the meeting along our lines of enquiry including cohort (Who should we be targeting?), outcomes (What does success look like?), funding (Who will pay for it?) and service providers (Are there existing providers able to achieve these outcomes?).

The bulk of the discussion this week centred on health, nutrition and development outcomes in pregnant mothers and children from 0-2 years. The list is by no means complete or finalized and may ultimately include outcomes as follows:

  • Exclusive breastfeeding at 3 and 6 months
  • Decrease in maternal depression
  • Antenatal visit (<14 weeks)
  • Uptake of state services including immunisations and child support grant (0-1 years)
  • Birth weight (>2500grams)
  • Weight and height for age
  • Weight for height
  • Decrease in pathology (Severe acute malnutrition, diarrhea, pneumonia)
  • Cognitive, social and emotional development (As assessed using tests such as Bayley Scales, Ages and Stages Questionnaire, Bradley HOME test)

These outcomes will need to be prioritized and assessed according to their mutual exclusivity, level of immediate and future impact, achievability by service providers (especially if the state is involved) and whether we can calculate credible current baseline data.

DSD and DOH procure home and community based services in isolation based on different sets of criteria. The question was raised as to whether it would be feasible to procure services on the basis of a cohort rather than on specific health or early learning outcomes and thus be able to combine forces to extend the reach of these services. This is a much more structural element to the work we are doing and will require a lot of thought and input over the coming months.

Finally, a concern has been raised by officials at various levels of government concerning the lack of process oversight inherent in the Impact Bond structure. This is a rational concern and something that governments across the world have grappled with when outsourcing traditional government functions and especially when implementing Impact Bonds. The structure allows service providers on the ground to deliver services in whatever way they deem fit, within regulatory and ethical boundaries, in order to generate positive outcomes. The government is concerned that these organisations will fail to do so without sufficient, evidence-based guidance from the state. Again this discussion will continue over the coming months as we talk through the pros and cons of this type of outcomes based procurement.

If you have any comments or queries on the process thus far please email Susan at This email address is being protected from spambots. You need JavaScript enabled to view it..We look forward to our Advisory Board meeting this month after which there will be more to share.