Global and local leaders gather to explore pay-for-success models
A major summit exploring innovative ways to finance South Africa's most urgent health and development priorities kicked off today, jointly hosted by the South African Medical Research Council (SAMRC) and the Presidency's Presidential Youth Employment Intervention.
The three-day Outcome Finance Alliance (OFA) gathering aims to unite international and domestic stakeholders to develop and evaluate strategies that could make pay-for-success financing instruments both cost-effective and scalable. The ultimate goal is to support development agencies and governments in meeting the United Nations Sustainable Development Goals.
Deputy Minister in the Presidency, Nonceba Mhlauli, was expected to open proceedings with keynote remarks.
With South Africa grappling with persistently high HIV infection rates, rising teenage pregnancies and mounting pressure on the broader health system, the need for fresh approaches to both service delivery and funding has become increasingly urgent. Outcomes-Based Finance (OBF), which ties funding directly to measurable results, is gaining traction as a practical mechanism to boost accountability, attract new investment and ensure scarce resources deliver tangible outcomes.
"The SAMRC looks forward to sharing key learnings and challenges, with the aim of identifying pathways to unlock further public–private partnerships that can accelerate the impact and institutionalisation of OBF."
Social Impact Bonds driving school-based health interventions
Central to the SAMRC's contribution at the summit is its pioneering work in Social Impact Bonds (SIBs) — a model that enables private and philanthropic investors to fund health interventions upfront, with government or donors repaying only when agreed outcomes are achieved.
The council's first SIB was rolled out through the Imagine Programme, a comprehensive initiative targeting adolescent girls and young women at high schools in Moretele and Newcastle — areas marked by elevated HIV prevalence and teenage pregnancy rates. Since its launch in 2023, the programme has delivered integrated sexual and reproductive health services directly within school settings, offering access to contraception, HIV testing, pre-exposure prophylaxis (PrEP), pregnancy care and referrals for further treatment, including continued support for those receiving antiretroviral therapy. Psychosocial support is also provided in dedicated safe spaces on school premises, helping to combat stigma and improve overall well-being among participants.
"This model fundamentally changes how we fund health interventions. By linking funding to verified outcomes, we are able to strengthen accountability, support innovation, and ensure that resources are directed toward interventions that make a measurable difference within health."
Those were the words of Dr Nevilene Slingers, Executive Programme Manager for Social Impact Bonds at the SAMRC, who emphasised the transformative potential of tying investment to proven results.
The OFA summit is expected to deepen collaboration among participants, facilitate the sharing of lessons learned and fast-track the adoption of financing models that place measurable impact at their core.
South Africa's strained public health system, burdened by one of the world's highest HIV rates and growing adolescent health crises, stands to benefit significantly if outcomes-based financing proves scalable. For ordinary South Africans, particularly young women in underserved communities, these models could channel private investment into frontline services where government budgets fall short. Should the summit produce workable frameworks, it may reshape how health programmes are funded and delivered nationwide in the coming years.
