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Performance-based Financing in Liberia: Experiences of USAID/RBHS

Performance-based Financing in Liberia: Experiences of USAID/RBHS. Richard J. Brennan Rebuilding Basic Health Services. Rebuilding Basic Health Services - Overview. Largest USAID-funded health project in Liberia Nov 2008 – Oct 2013

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Performance-based Financing in Liberia: Experiences of USAID/RBHS

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  1. Performance-based Financing in Liberia: Experiences of USAID/RBHS Richard J. Brennan Rebuilding Basic Health Services

  2. Rebuilding Basic Health Services - Overview • Largest USAID-funded health project in Liberia • Nov 2008 – Oct 2013 • Overall goal: assist MOHSW with implementation of National Health Plan • Three pillars • Service delivery • Systems strengthening • BCC • Service delivery • Implemented through performance-based contracts

  3. Performance-based Financing in Liberia • RBHS PBCs • July 09 – June 11 • 4 NGOs (5 contracts) • 1 NGO grant; 15 facilities • MOHSW Pool Fund • November 2009 • March 2010

  4. PBF and RBHS • Objectives of PBCs • Service delivery at facility & community levels • Capacity building of CHTs • Indicator selection • Highly consultative • Determining baselines and targets • Individualized by NGO

  5. Administrative Indicators • Reported quarterly; possible penalty associated

  6. Performance Indicators • Reported quarterly: annual performance bonus (year 1); quarterly bonus (from year 2)

  7. PBF Management:Verifying data • Process • Quarterly • Random selection of 3 facilities per NGO • Cross check reports with ledgers / records • Challenges • Definitions, e.g. supportive supervision • Reporting issues, e.g. ORS, ACT • Discrepancies between facility reports and ledger reviews by RBHS

  8. PBF Management:Verifying Data • Progress: Quarter 1 to Quarter 6 • Clarification of definitions • Data verification instituted by NGOs • Fewer discrepancies • Results • Increased capacity in data management – facility and NGO staff • Improved data quality • Improved understanding and use of data

  9. PBF Management: Feedback & Communication • Monthly all-partner meetings • Quarterly data reviews – all partners, MOHSW • Quarterly partner feedback • Annual stakeholders’ meeting • Others • County Coordinator reports • Ad hoc meetings • Field visits

  10. Distribution of Performance Bonuses • Frequency • Year 1: Annual bonus • Year 2: Quarterly bonus • Incentive systems determined by NGO partner, CHT, and health staff • Distributed at all levels • CHT • Facility • Community • NGO staff

  11. Distribution of Performance Bonuses

  12. Support to MOHSW • Selection and harmonization of national indicators • Determination of preliminary baselines and targets • Development of PBC payment plan and tool

  13. Lessons learned • Need precision in indicator definitions • Importance of flexibility and leniency in setting targets and assessing progress • Value of validation process in building capacity • Annual payment of bonus too infrequent • Need to provide more guidance on bonuses

  14. Future directions • Improve data collection with new HMIS • Involve CHT members and facility staff more in tracking PBF • Introduce facility feedback tool • Graphs of last 12 months’ data updated monthly • Posted at each RBHS facility and updated monthly

  15. Future Directions • Support to MOHSW on PBF • Develop PBF database (national and country level) with MOHSW • Conduct costing of PBF program (management costs and future extension) • Development of the national PBF procedures manual • Development of PBF M&E and verification manual and tools

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