Post on 15-May-2015
description
Community RBF-‐ What do We Know-‐ and What Can We Expect?
RWANDA Catherine MUGENI
Head of community health desk Ministry of health
Argen7na, 25 March 2014
Short summary • The scaling up Started in 2009 • CPBF is implemented at the sector level/HCs in Rwanda and
this looks all the CHWs acIviIes in the community. • Rwanda has 45,000 CHW volunteers, 3 per village: 1 Male & 1
Female health worker (called Binome), 1 Maternal and Child Health Promoter(called ASM).
• CHW’s form cooperaIves in catchment areas of each health center. The cooperaIve receives PBF payments as an incenIve and undertakes income-‐generaIng acIviIes (milk, transport, goat raising, etc..).
• 30% of PBF payments can be shared as individual payments to CHWs, 70% is used as capital for the cooperaIve’s income generaIng acIviIes. This 70% of earnings capital will be used in the future if donors stop fundings.
Community RBF indicators
• Pay for indicators: CHW cooperaIves receive a quarterly payment based on changes in the 8 target indicators: 1. NutriCon Monitoring: number of children (6-‐59 months) monitored and
referred for nutriIon status,
2. Antenatal care: number of women accompanied/referred to the health center for antenatal care before or during 4 month of pregnancy,
3. Deliveries: number of women delivering at the faciliIes,
4. Family Planning: number of new family planning users referred by CHWs cooperaIves to the health center,
5. Family Planning: number of regular users of modern contracepIves at the health center.
6. Tuberculosis : -‐ Number of persons suspected to have TB referred to the health center
-‐ Number of TB paIents receiving DOTS at home 7. HIV : -‐ Number of people referred to health center for VCT
-‐ Number of women referred to health center for PMTCT
8. Monthly report ( completeness , Accuracy , Timeless )
IntervenIons
• All cooperaIves’ reports are assessed each quarter for data completeness and report submission Imeliness, internal. The evaluaIon of cooperaIve management is carried out by the district hospital. Each quarter, 100% of cooperaIves are evaluated.
• VerificaIon by the Health FaciliIes of the quanIty by referrals and the monthly report
• Quarterly counter verificaIon by the sector steering commicee
• Quarterly counter verificaIon by the district steering commicee to the sector steering commicee
• Quarterly Payment and when payment are made, the money is injected into CHWs cooperaIves to improve their business status and their standard of living in the community
The key challenges for Community RBF • VerificaIon data: Data flows from many villages and from
many CHWs ; this is a painstaking work to ensure data quality.
• Some Indicators are set at a high target and this is difficult to be achievable ,Eg FP
• Control and counter verificaIon data: The differences in data that is the role of sector steering commicees in controlling and counter verificaIon data is insufficient and not done regularly. Data needs to be verified before validaIon
• Data discrepancies between HMIS and those validated by the sector steering commicees. This oien acributed to the transcribed data to registers from compilaIon to the CHWs monthly report form.
• lack of sancIons for inaccuracy reported indicators
key messages • IntroducIon of Quality data assessment tool (QDA) to idenIfy the factors that contribute to the quality of community data at each step of the data collecIon and reporIng process; disInguish between good quality data and poor data; IdenIfy strategies to improve the community data collecIon system
• Start to use RapidSMS data to incited CHWs to report accurate data
Percent of CooperaIves that reached at least 50%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
2012-‐3 2012-‐4 2013-‐1 2013-‐2 2013-‐3 2013-‐4
PBF Com Control
PBF Com Demand
PBF Com Supply
PBF Com Supply and Demand
CHWs COOPERATIVE
• Q4 2013 PBF payment : • HIV: 466.294$ • TB: 346.842 $
• Profit in 2013 : 545.695$ • Average ProjecIon profit in 2014 : 6.271.033$ • Total ASSET :18.259.988 $
THANKS
QUESTIONS ?