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National Community Health Performance-based Financing: design and implementation of supply-side model

National Community Health Performance-based Financing: design and implementation of supply-side model. PBF workshop Bujumbura February 16 th , 2011 Ludwig De Naeyer (MSH). Rwanda CPBF Interventions.

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National Community Health Performance-based Financing: design and implementation of supply-side model

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  1. National Community Health Performance-based Financing:design and implementation of supply-side model PBF workshop Bujumbura February 16th, 2011 Ludwig De Naeyer (MSH)

  2. Rwanda CPBF Interventions • Second generation of PBF to address remaining barriers for achieving improved MCH outcomes and TB outcomes • Choice and unit fee based on national priorities and expected quantities mainly for preventive activities • CHW cooperatives receive incentives payment for: • Timely submission of quality SIScom reports • Offer for 5 MCH-indicators and 2 TB-indicators

  3. Quantity Indicators (selection of SIScom)

  4. Cooperative performance and Reporting(quality aspect)

  5. Cooperative Income 2009 (data WB/SPH)

  6. 2010 CHW Cooperative Data

  7. Cooperative functioning (data WB/SPH) • 47% of cooperatives and 38% of CHW charge patient fees

  8. 2010 CHW Cooperative Data

  9. Data validation and control • Payment per unit reported so possibility of gaming • Still mainly paper based • Done by HC supervisor monthly • External audits planned but not performed yet

  10. PBF-Payment for cooperative • Quarterly via HC-account • After validation of the data by sector steering committee (members are HC-head, the supervisor of the CHWs at the HC, the in charge of social affairs and a member of the civil society) • Two parts: • Maximum amount for reporting depends on the target population of the cooperative. This is adjusted by the quality score. • Productivity (i.e. offer services) = unit fee * Quantity • First payment made for October – November 2010: average of 3700 $ for indicator and 900 $ for report • Cooperatives use earnings for income generating activities and for dividend for CHWs.

  11. Cooperatives Reporting: 97% for 2010 to date out of 427 HC and Dispensaries

  12. Cooperative performance reports • Started during the last quarter 2010 (n=261) • Average quality score: 82%

  13. Baseline data for “Incentivized” Indicators

  14. Lessons learnt / challenges • PBF incentives ensured rapid increase in SISCom reporting • In the presence of a strong monitoring system PBF can be introduced for cooperatives to stimulate and reward activities of CHWs at community level. • Quarterly payments are feasible and will hopefully lead to an increase of MCH and TB-activities. The results of this intervention will be assessed by an independent unit through an Impact Evaluation study. • Data quality supervision and external audits still need to be introduced to verify data quality

  15. 2010 CHW Cooperative Data • In the past 12 months, how many times was performance assessed? • Members (internal): 3.97 • Members (external): 1.18 • Cooperative (external): 0.52

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