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CHAZ PBF Experience

CHAZ PBF Experience. PBF Conference for the Multi-country network held in Burundi 14 th – 17 th February 2011 Churches Health Association of Zambia Box 34511, Ben Bella Road, Lusaka, Zambia Phone 260 1 229702/237328, Fax: 260 1 223297, Cell: 0979568292/0977790499 Email: ed@chaz.org.zm

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CHAZ PBF Experience

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  1. CHAZ PBF Experience PBF Conference for the Multi-country network held in Burundi 14th – 17th February 2011 Churches Health Association of Zambia Box 34511, Ben Bella Road, Lusaka, Zambia Phone 260 1 229702/237328, Fax: 260 1 223297, Cell: 0979568292/0977790499 Email: ed@chaz.org.zm Website www.chazhealth.org

  2. Hesent them to Preach the Kingdom of God and Heal the sick ” Luke 9:2

  3. CHAZ Background Information • Formation & Membership • Formed in 1970 ( Catholic and Protestant Medical Committees) • Interdenominational (Catholic and Protestant) umbrella organisation for 146 CHIS in 9 Provinces and 56 Districts (out of 72): • 36 Hospitals & 81 RHCs & 9 Training Schools • 29 CBOs: 20 Community Based Programmes & 9 Catholic Dioceses • Health Services Coverage • CHAZ is the second largest provider of health services in Zambia. • MoU with the MoH: 75% Grant, 90% Staff , 90% Essential Drugs • Principal Recipient Status • PR for the Global Fund Mechanism in Zambia for all the 3 disease components: HIV/AIDS (including ART), Malaria & TB. • Others • Recipient of the Joint Financial Arrangement (JFA) • One of the major PBF implementers in the country “He sent them to preach the Kingdom of God and heal the sick” Luke 9:2

  4. Project objectives Overall objective The overall purpose of the PBF project is to safeguard health sector performance and contribute to the achievement of a better health status of the Zambian population. Specific Objectives • To build capacity among church health and government institutions and the CHAZ secretariat for the gradual introduction of performance based financing • To document experiences, conduct action research and share lessons learnt on PBF and its various dimensions • To promote effective community participation in relation to PBF • To actively take part in the international network of exchange (community of practice) on PBF that is unfolding.

  5. Project Expected Outcomes

  6. History of P4Pin Zambia In 3 Dioceses (Mansa, Mpika and Chipata) 6 hospitals, 7 health centres Mansa Diocese: (started 1-1-2007),St. Paul’s Hospital, Lubwe Hospital, Kasaba Hospital, Health desk Chipata Diocese Minga Hospital (started 1-1-2007), Lumezi Hospital (started 1-1-2008), Kanyanga HC (started 1-1-2008), Muzeyi HC (started 1-1-2008), Health Desk (started 1-1-2008) Mpika Diocese: Our Ladies Hospital (Chilonga) (started 1-1-2007), Chalabesa HC, (started 1-7-2008), Mulanga HC (started 1-7-2008)Ilondola HC (started 1-7-2008), Mulilansolo HC (started 1-1-2009),Health Desk (started 1-7-2008) “He sent them to preach the Kingdom of God and heal the sick” Luke 9:2

  7. P4P Evaluation • Evaluation was done in the 3 dioceses • Revealed both positive and negative outcomes • Recommended the involvement of a local stakeholder (CHAZ) in project management • Extensive involvement of the stakeholders in health • Identified a need for a pilot on proper PBF interventions • Use of a more contextualized approach in the design process “He sent them to preach the Kingdom of God and heal the sick” Luke 9:2

  8. The CHAZ PBF Pilot Project • 2 districts selected for PBF piloting • Selection based on a set criteria • EU Funded PBF is a multi country project, • Pilot implemented in 3 years from Jan 2010 – Dec 2012

  9. Implementation strategies Seven core strategies will be employed to implement the project: • Actual (co-)financing of (health) services based on past performance, through the conclusion of service agreements for church health institutions • Capacity building • Exchange visits and peer review • Action research • Site visits for monitoring purposes • Consultation at national, district and community level • Documentation and dissemination

  10. CHAZ INVOLVEMENT • Following the recommendation for CHAZ involvement in P4P • In July 2009 CHAZ studied the P4P situation and sensitized the stakeholders on PBF development • Advocacy for PBF to all stakeholders • Developed institutional framework (WB, UNZA, MoH, DHMT) • Shared PBF strategies with the TWG-MoH • TWG accepted the CHAZ PBF strategy • Selected districts shared with MoH

  11. Pilot District Selection Criteria • Rural district • Church presence (in view of Govt/FBO collaboration), in particular: the number of hospitals and h/centres and share of churches’ catchment population as a % of total district population • P4P history (with Cordaid) • Not an RBF district (intervention or control district) in the WB supported project • Workload in terms of staff/contact ratio: preferably average (neither high nor low) • Disease burden: child malnutrition (% underweight), pneumonia, % institutional deliveries • Catchment population served by church health institutions: ideally not more than 100,000.

  12. District Selection

  13. Selection Cont’n

  14. CHAZ /PBF Implementation Structure The project emphasizes on split of responsibility • Fundholder Agency - CHAZ • Regulator – quality standards - DHMT • Local Purchasing Agency – responsible for contracting - ZSIC • Local Verifier Organisation– client satisfaction surveys • Health facilities – DOPE and DAPP • Community organizations/committees – NHC, HCC, HAC

  15. Verification procedure Quality • Done by local quality experts with performance contracts • Follow agreed upon quality standards • Give a score expressed in percentage • Quality will determine the absolute score (rewards =Quality*quantity*performance index) Quantity/data verification • Conducted by the LPA - ZSIC • Produces provisional invoices based on data results Client Tracer surveys • Conducted by a locally based NGO – contracted • Results inform the next quarter business plans for the facility • In future, survey results will determine Invoices • Are consolidated by the PBF district steering committee

  16. Where are we? • Project design finalized • Actual implementation commenced in July, 2010 • Baseline survey conducted • Desk review on existing levels of performance contracting in CHAZ • Performance verification for quarter three (2010) conducted • Project implementation manual • Capacity building activities for policy makers and implementers • Collaboration with other stakeholders - Trainers, LPA, Local verifier organizations • Shared experiences with stakeholders in the country

  17. Selected Indicators/ costs

  18. Quarter 3 (2010) results

  19. Sustainability plan for the CHAZ PBF scheme: • Involvement of other critical stakeholders (Local purchaser, Community organisations, MoH, UNZA) • Member of the TWG-HCF and the PBF national steering committee • Transparency about PBF-funding / Inequity • Intergrated planning and reporting for PBF • Community involvement – possible gradual intriduction of pre-financing schemes • Gradual intergration of PBF into the routine CHAZ program management “He sent them to preach the Kingdom of God and heal the sick” Luke 9:2

  20. Thank you for your attention

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