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PERFORMANCE BASED FINANCING IN BURUNDI

PERFORMANCE BASED FINANCING IN BURUNDI. By Dr Longin GASHUBIJE «  Flagship workshop on Health System Strengthening Financing for Results   » 21 june to 02 july 2010 ». 1. INTRODUCTION .

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PERFORMANCE BASED FINANCING IN BURUNDI

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  1. PERFORMANCE BASED FINANCING IN BURUNDI By Dr Longin GASHUBIJE « Flagship workshop on Health System StrengtheningFinancing for Results  » 21 june to 02 july 2010 »

  2. 1. INTRODUCTION • Burundi’s National Plan for Health Development emphasizes strengthening the performance of the health system(contractual approach, decentralization). • In 2004 an analyses (EtatsGénéraux de la Santé) identified the following challenges for Burundi's health system: • Shortage of health staff in rural areas • Unstable and poorly motivated professionals • Poor quality health services • Poorly managed health system • Poor access of the population to most Minimum Health Package activities

  3. 3. IMPLEMENTING PBF IN BURUNDI • A national contractual approach policy was formulated in 2006. • The Ministry of Health encouraged NGOs (CORDAID and HealthNet-TPO) to start PBF pilot projects. • Dec 2006 the main stakeholders validated the documents of contractualisation. • Nov 2006 onwards PBF pilots started in 3 Provinces : Bubanza and Cankuzo and Gitega

  4. 3. IMPLEMENTING PBF IN BURUNDI (2) • The document was validated in December 2006 by the main stakeholders : it became a reference for the partners but the government remained accountable for its national health objectives. • From November 2006 onwards performance based financing pilots started in 3 Provinces : Bubanza and Cankuzo (CORDAID) and the Health District of Kibuye in Gitega province (HealthNet TPO)

  5. IMPLEMENTATION OF PBF • In may 2009 an analysis of OUTPUT (8/9), QUALITY( 5/9) and EQUITY( 9/9)results 2006 – 2008 study comparing PBF provinces (Cankuzo and Bubanza) with 2 control provinces (Karuzi and Makamba) • Results was relevant for our HS and the governement decided to emplement the PBF in 9/17 Prov

  6. 5. Rolling out PBF during 2009. April 2010: All provinces covered

  7. 6. Achievements: separation of functions to promote good governance in the context of the PBF approach in BURUNDI • The Regulatory function is assured by the Ministry of Health and its decentralized entities (BPS and BDS) • The Verification function is assured by the Provincial Validation and Verification Committee (CPVV) and local NGOs at the community level • The Provider function is assured by health centers and hospitals • The Financing function is assured by the government and its aid agency partners • Community voice strengthening is assured though Health workers (ASC), members of local government parliaments as well as through health facility committees (COSA) and local NGOs (associations locales)

  8. 6. Achievements of PBF in Burundi (2) • Supervision is now regular and based on PMA and PCA indicators aiming to reach the MDG’s • Burundi developed a national per capita budget whereby each Province has its « virtual « budget » (= spent by CPVV after negotiation of performance contracts with health providers but paid at central level !)

  9. 6.Achievements of PBF in Burundi (3) • At the national level costing per capita • At provincial level each HF is classified according to equity ratings (distance to center, number of qualified health professionals ,density of the population , road conditions, poor infrastructure, vulnerable population)

  10. 6. Achievements of PBF in Burundi (4) • Government introduced a management tool for paying individual staff bonuses at health facility level « outild’indice ». This promotes transparency and prevents intra health staff conflicts. • Health professionals are now dynamic and the voice of the community can be heard through the health workers ,the local Parliaments and local association

  11. 6. Achievements of PBF in Burundi (5) • A web based application is being developed where provinces submit their invoices using their virtual budgets. This system assures transparency and reduces bureaucratic procedures (stakeholders such as government officials, aid agency representatives , provincial CPPV officials) with a pass word can follow the payments to health facilities by Ministry of Finance or aid agencies such as the EC (through Cordaid), bilateral agencies, etc

  12. 7. Challenges • How to further integrate PBF and free health care for pregnant women, deliveries and children under 5 years ? • How to better coordinate aid agency partners for PBF? • To strengthen the health referal system (RCR) • Better integrate the National Hospitals in PBF system • Organize an insurance system • How to strengthen public /private partnerships (pharmacies , providers , ...) • Further develop health facility infrastructure • Strengthen financial sustainability

  13. 8 CONCLUSION • The implementation of PBF was an issue of a dialogue among Partners and government based on scientific studies with participation of all the stakeholders . • The government remains the principal responsible actor for the health system • The PBF pilot experiences were a success that is why it is no generalized in all the country • We still face many challenges to achieve the MDG’s

  14. MURAKOZE, MERCI, AKSANTE ,THANK YOU

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