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Results-based Financing for Health in Tanzania Health Financing Technical Working Group Meeting

Results-based Financing for Health in Tanzania Health Financing Technical Working Group Meeting 28 th August 2015 Ministry of Health and Social Welfare. Presentation outline. RBF definition Purpose and goals of RBF in tanzania Institutional set up

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Results-based Financing for Health in Tanzania Health Financing Technical Working Group Meeting

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  1. Results-based Financing for Health in Tanzania Health Financing Technical Working Group Meeting 28th August 2015 Ministry of Health and Social Welfare

  2. Presentation outline • RBF definition • Purpose and goals of RBF in tanzania • Institutional set up • Indicators and factors considered in pricing quality indicators • Available financial resources for RBF implementation • Fund flow in RBF implementation • Invoicing and payment • Progress made • Quality results • Timeline and next steps • Sustainability strategy

  3. What is RBF for health? Results-Based Financing (RBF) – Umbrella term applicable to many sectors RBF for Health – “a cash payment or non-monetary transfer made to a national or subnational government, manager, provider, payer or consumer of health services after predefined results have been attained and verified” (www.rbfhealth.org)

  4. Role of RBF in health • RBF in the health sector is needed to: • Help focus attention on outputs and outcomes • Example: the number of women receiving antenatal care or taking children for regular health and nutrition check ups to reduce child mortality rather than inputs or processes (i.e., training, salaries, medicines). • Balance resource allocations to elevate low performing indicators and maintain existing achievements (like immunizations) to accelerate progress toward national health objectives. • Increase use, quality and efficiency of services

  5. Why RBF in Tanzania? • There has been slow progress in achieving some health objectives despite a significant increase in inputs • RBF is an innovation which promotes efficiency in health care delivery • It has observed effects in strengthening health systems • It can be harnessed to move along the road of Universal Health Coverage • Efficient use of limited resources for more and quality output • Enhance D by D implementation up to the level of HFs

  6. Goals of Tanzania’s RBF Overall goals • Strengthen the health system • Accelerate Tanzania mainland’s move to UHC • Help focus government and donor attention on outputs and outcomes • Re-orient mindset of health service providers Immediate goals • Increase utilization of specified services in health facilities • Increase quality of service provision • Incentivise more focused health workers and management teams

  7. INSTITUTIONAL SET UP

  8. Institutional setup - Roles

  9. Quantity indicators for dispensaries & health Centers

  10. RBF QUANTITY INDICATORS PRICING FACTORS • The index indicator was OPD and was given 1 as basic Unit of weighing other indicators, • Priority by indicators, • Coverage, • Available funds for incentives.

  11. 18 AREAS FOR DIPENSARY QUALITY ASSESSMENT

  12. 26 AREAS FOR D.HOSP & COMPREHENSIVE HC Q. ASSESSMENT

  13. 12 AREAS FOR CHMT ASSESSMENT

  14. 10 AREAS FOR RHMT ASSESSMENT

  15. 3 AREAS FOR IAG ASSESSMENT

  16. ALLOCATION OF BUDGET

  17. Fund flow for RBF system

  18. Funds Flow

  19. Flow Charts-Invoicing & Payments

  20. CURRENT SCOPE OF PILOT & TIMELINE SHINYANGA-KISHAPU DISTRICT HAS STARTED PILOT: • 41 Dispensaries, 4 Health Centres of Kishapu and 1 District Hospital of Kahama are now piloting RBF system since April 2015. • The performance agreements have been signed by the Providers side and Purchaser • Verification of 1st quarter of implementation (April June) 2015 was recently done for the above Health Facilities • The RBF Invoicing and data analysis component is now integrated into the MOHSW DHIS2 by the contracted University of Dar es salaam, • Data entry is concluded and the approval process by the Regional RBF Committee is about to take place.

  21. READINESS ASSESSMENT RESULTS BY BRN STAR RATING

  22. Trainings & Orientations Attendance

  23. ATTENDANCE BY GENDER

  24. KISHAPU QUALITY ASSESSMENT RESULTS 1st Q2015 KAHAMA DH GOT 46.4% AND KISHAPU CHMT GOT 59.1%

  25. TIMELINE & NEXT STEP

  26. Sustainability of RBF as envisioned by Health Care Financing Strategy Reimbursement to Facilities Matching Payment to MBP Based on Core Output-Based Payment Systems, Performance (RBF) and Star Rating (BRN)

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