dr. michael m. amara, principal health economist, mohs
DESCRIPTION
DR. Michael M. Amara, PRINCIPAL HEALTH ECONOMIST, MoHS. Health Development Partners Meeting PERFORMANCE-BASED FINANCING (PBF) Presentation 22 nd august 2012. Outline of the Presentation. PBF defined PBF in Sierra Leone –Objectives and rationale Some benefits of PBF Processes - PowerPoint PPT PresentationTRANSCRIPT
DR. Michael M. Amara,PRINCIPAL HEALTH ECONOMIST,
MoHS
Health Development Partners Meeting
PERFORMANCE-BASED FINANCING (PBF)
Presentation
22nd august 2012
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Outline of the Presentation • PBF defined• PBF in Sierra Leone –
Objectives and rationale• Some benefits of PBF• Processes• PBF Component• PBF Actors Tree
• PBF in PHUs• PBF Results• Use of the investment
component• Lessons Learnt• Challenges• Conclusion
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What is PBF?Financial mechanism which provides finances
for performance (payment for output), Payment for Reward or payment for result.
It is an approach in health financing that shifts attention from inputs to output, and eventually outcomes, in health services.
Also known as Results-Based Financing
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Objectives of PBF in Sierra Leone
General objective:To change the behaviour of health providers at
health facilities level for them to deliver more quality services sustainably and thereby
to increase their productivity in the health sector.Specific objectives:Provide financial incentives to health facilities in
order to increase quality of health care services.To improve quality of service delivery at health
facilities level.
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Rationale for PBF in Sierra LeoneHigh mortality and morbidity especially
among young children and mothers.
Financial barriers preventing mothers and children from accessing health care are being tackled through the Free Health Care policy.
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We can use PBF to: Improve health services in Sierra Leone
Change the attitude of health workers
Increase health workers productivity
contribute to achieving the Millennium Development Goals.
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PBF components
1. Staff incentives: 60% of the quarterly package (Maximum)
2. Investment: 40% (Minimum)
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Processes
Technical discussions with World Bank
Joint study tour by the MoHS, MoFED and World Bank staff to Rwanda and Burundi
Developed Operational Manual
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Developed training manual
Conducted Training of Trainers (ToT) for M&E of both DHMTs and Local Councils, District Health Sisters and some key staff.
Conducted Cascade training for all In-charges of PHUs.
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Tripartite Agreement signed between, the Mayors/Chairmen, DMOs, and In-charges.
Tripartite Agreement signed between the Mayor, Chief Medical Officer and Hospital Superintendent of (Ola During and PCMH)
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PBF Actors and Functions
VerifierVerifies accuracy of
performance reports
ProviderDelivers health services
to beneficiaries
Beneficiary
RegulatorSets up the ‘rules’: indicators, prices,
verification process
PurchaserContracts provider to
deliver health services
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Institutional Structure and Agreements
REGULATORREGULATORFUND HOLDERFUND HOLDER SERVICE PROVIDERSERVICE PROVIDER INDEPENDENT VALIDATORINDEPENDENT VALIDATOR
MoFED: Local Govt. Finance Department
MoFED: Local Govt. Finance Department
Independent Validation
Agency Contract
Tripartite PBF Agreement
Tripartite PBF Agreement
Peripheral Health Unit or
Clinic
Peripheral Health Unit or
Clinic
Independent Validation
Agency
Independent Validation
Agency
District Health Management
Team
District Health Management
Team
Ministry of Health and Sanitation
Ministry of Health and Sanitation
PBF Supervision/ Verification Agreement
PBF Supervision/ Verification Agreement
Local CouncilLocal Council
Health Management
Committee
Health Management
Committee
Institutional Structure of PHU’s
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Institutional Structure of HospitalsFUND HOLDER:
MoFED/IPAU
PURCHASER AND REGULATOR: MoHS
PROVIDERS: PCMH & ODCH
VERIFIERS: PEER REVIEW HOSPITAL + MoHS PBF & HOSPITAL DIRECTORATE
Performance transfer payment
Performance transfer payment
Performance contract
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No. ACTIVITY MAXIMUM SCORES
SCORES OBTAINED
1 General organization 100
2 Human resources management 100
3 Financial management 100
4 Pharmacy management and
prevention of drugs stock out 150
5 Hygiene and sanitation 100
6 Customer care 100
7 Health care services 250
8 Laboratory 100
TOTAL 1000
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PBF Interventions for PHUsThe PBF Scheme is based on six key RCH interventions:
•Family planning (BPEHS 7.2)
•Antenatal care of pregnant women (BPEHS 7.1.1.)
•Safe childbirth deliveries (BPEHS 7.1.2)
•Postnatal care of mothers and babies(BPEHS 7.1.4)
•Routine immunisations for children under one (BPEHS 7.6)
•Outpatient consultations for children under five (BPEHS 7.7)
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PBF PRICES for 2011
PBF Indicator Old Price Revised Price
N1 = Number of new acceptors of modern family planning methods. 1,000 1,000
N2 = Number of pregnant women completing series of four antenatal consultations. 6,000 7,000
N3 = Number of pregnant women in labour attended by a health professional, at the facility. 10,000 15,000
N4 = Number of women completing series of three postnatal consultations 6,000 7,000
N5 = Number of children aged less than 12 months completing national EPI immunization course. 6,000 7,000
N6 = Number of outpatient visits of children under five 300 500
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PBF RESULTS
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SUMMARY OF PHUs PAID FOR 1ST AND 3RD QUARTERSQtry 1 Qtry 2 Qtry 3
No District
Existing
PHUs
PHUs
paid
PHUs
paid
PHUs
paid1 Bo 109 107 108 110
2 Bombali 95 95 97 91
3 Bonthe 51 46 41
4 Kailahun 76 76 77 77
5 Kambia 60 63 63 62
6 Kenema 117 121 121 114
7 Koinadugu 68 54 68 688 Kono 75 75 24
9 Moyamba 92 94 95 86
10 Port Loko 108 102 102 9811 Pujehun 64 63 63 61
12 Tonkolili 90 89 89 83
13 Western Area 76 70 90 83
1,081 1,055 973 998Total
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Use of the Investment Component
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Lessons learntDesigning and preparation of documents (OM,
Tripartite Agreement etc)was done by the country team and has led to strong ownership of the program.
Pool of experts has being created as a result.
Improvement in quality and utilization
Competition leading to innovations for better service delivery.
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Lessons Learnt contd. Direct payment of incentive package into respective bank accounts of the facility.
Verification of reported data through the existing DHIS strengthens the system
We are using PBF to strengthen monitoring of health facilities especially in hard to reach areas and ensuring improvement of quality of services
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ChallengesInadequate human resource especially at facility
level. (some facilities with one staff)
Geographic and socio-economic diversities favours some health facilities whilst others are disadvantaged.
The banking systems were not initially ready for bank to bank transfers to the smaller institutions (health centers and posts), etc.
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Challenges contd.
Delays in submitting verified reports by DHMTs (Mentoring strategy).
Difficulties in accessing some facilities (due to poor road network, riverine areas, mountains etc)
Capacity building at facility levels (mentoring strategy)
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Challenges contd.
Initial stock out of drugs
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MAURITANIA
MALI
SENEGAL
THE GAMBIA
GUINEA BISSAU GUINEA
SIERRA LEONE
LIBERIA
CÔTE D’IVOIRE
BURKINA FASO
GH
AN
ATOGO
BE
NIN
NIGERIA
NIGERCHAD SUDAN
CA
ME
RO
ON
CENTRAL AFRICAN REPUBLIC
ERITREA
ETHIOPIA
SOM
ALIA
KENYAUGANDA
RWANDA
BURUNDICO
NG
O
GABON
EQUATORIAL GUINEA
SAO TOME AND PRINCIPE
ANGOLA
NAMIBIABOTSWANA
ZAMBIA
TANZANIA
MALAWI
ZIMBABWE
MO
ZAM
BIQ
UE
SOUTH AFRICA
SWAZILAND
LESOTHO
MA
DA
GA
SC
AR
MAURITIUS
COMOROSMAYOTTE (Fr.)
SEYCHELLES
DEM. REP.OF CONGO
National Scale-up (3)Pilots Ongoing (12)Advanced Planning (8)
Under Discussion (8)
Impact Evaluation (8)
The RBF in South Sahara Africa
The RBF in South Sahara Africa
Conclusion and Next Steps
Next Steps
Hiring of independentagency to verify andvalidate PBF data.
Conclusion PBF is being used successfully to
complement the free health care and to strengthen entire health system inspite of the challenges mentioned.
Does not change the existing structures of the health system, but rather strengthens it.
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Thank YouThank You
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