The South African Medical Research Council (SAMRC) together with the Presidency of South Africa’s Presidential Youth Employment Intervention will host the Outcome Finance Alliance (OFA) summit from 25–27 March, bringing together global and local partners to advance the use of Outcomes-Based Financing (OBF) in addressing South Africa’s most pressing health and development challenges.
The OFA objective is to design and test strategies to make pay-for-success financing instruments a cost-effective and scalable proposition to support development agencies and governments to deliver on the UN Sustainable Development Goals.
As South Africa continues to confront high rates of HIV infection, teenage pregnancy, and broader health system pressures, innovative approaches to both service delivery and financing are becoming increasingly critical. Outcomes-Based Finance, which links funding directly to measurable results, is emerging as a practical tool to improve accountability, unlock new investment, and ensure that limited resources deliver real impact.
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.
At the centre of the SAMRC’s contribution 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. This shifts the focus from funding activities to delivering measurable improvements in people’s lives.
The SAMRC’s first SIB was implemented through the Imagine Programme, a comprehensive intervention targeting adolescent girls and young women in high schools in Moretele (North West) and Newcastle (KwaZulu-Natal), areas with high HIV prevalence and teenage pregnancy rates.
Launched in 2023, the programme delivers integrated sexual and reproductive health services directly within schools, including access to contraception, HIV testing, pre-exposure prophylaxis (PrEP), pregnancy care, and referrals for further treatment, including ongoing support for those on antiretroviral therapy. The programme also provides psychosocial support in safe spaces on the school grounds, , helping to reduce stigma and improve overall well-being.
Early insights from the programme highlight the importance of improved contraceptive counselling and choice, strengthened mental health support, and more responsive approaches to addressing stigma faced by pregnant young women. The programme was successful in demonstrating achievement against the ambitious outcomes targets for coverage of contraception, antiretroviral therapy and Pre-exposure prophylaxis, with less successful identification of pregnant girls but good timeous linkage of those identified to the relevant services.
The upcoming Outcome Finance Alliance convening provides an opportunity to deepen collaboration, share lessons, and accelerate the adoption of financing models that prioritise impact. As fiscal pressures continue to mount, these approaches offer a pathway to strengthen health systems while ensuring that investment translates into meaningful and measurable outcomes for communities.
“This model fundamentally changes how we fund health interventions,” said Dr Nevilene Slingers, Executive Programme Manager for Social Impact Bonds at the SAMRC. “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.”