CHAZ PBF ExperienceCHAZ PBF Experience

PBF Conference for the Multi-country network held in Burundi1414thth –– 1717thth February 2011February 2011

Churches Health Association of ZambiaBox 34511, Ben Bella Road, Lusaka, Zambia

Phone 260 1 229702/237328, Fax: 260 1 223297, Cell: 0979568292/0977790499Email: ed@chaz.org.zm

Website www.chazhealth.org

• He sent them to Preach the Kingdom of God and Heal the sick ” Luke 9:22

CHAZ Background Information CHAZ Background Information

“He sent them to preach the Kingdom of God and heal the sick” Luke 9:2

Formation & Membership• Formed in 1970 ( Catholic and Protestant Medical Committees)• Interdenominational (Catholic and Protestant) umbrella organisation for

146 CHIS in 9 Provinces and 56 Districts (out of 72):• 36 Hospitals & 81 RHCs & 9 Training Schools • 29 CBOs: 20 Community Based Programmes & 9 Catholic Dioceses

Health Services Coverage• CHAZ is the second largest provider of health services in Zambia. • MoU with the MoH: 75% Grant, 90% Staff , 90% Essential Drugs

Principal Recipient Status • PR for the Global Fund Mechanism in Zambia for all the 3 disease

components: HIV/AIDS (including ART), Malaria & TB.Others• Recipient of the Joint Financial Arrangement (JFA)• One of the major PBF implementers in the country

Project objectivesOverall objectiveThe overall purpose of the PBF project is to safeguard health sector performance and

contribute to the achievement of a better health status of the Zambian population.

Specific Objectives• To build capacity among church health and government institutions and the CHAZ

secretariat for the gradual introduction of performance based financing

• To document experiences, conduct action research and share lessons learnt on PBF and its various dimensions

• To promote effective community participation in relation to PBF

• To actively take part in the international network of exchange (community of

practice) on PBF that is unfolding.

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Project Expected Outcomes

1. The voice of the client is strengthened.

2. Improved CHAZ capacity to expand and promote PBF independently

3. Actively piloted PBF strategy in government and mission facilities in two districts

4. Harmonised of the PBF approach between CHAZ and MoH

5. Local capacity built in training on PBF

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History of P4Pin Zambia

“He sent them to preach the Kingdom of God and heal the sick” Luke 9:2

In 3 Dioceses (Mansa, Mpika and Chipata) 6 hospitals, 7 health centresMansa Diocese: (started 1-1-2007),St. Paul’s Hospital, Lubwe Hospital, Kasaba Hospital, Health desk

Chipata DioceseMinga Hospital (started 1-1-2007), Lumezi Hospital (started 1-1-2008), Kanyanga HC (started 1-1-2008), Muzeyi HC (started 1-1-2008), Health Desk (started 1-1-2008)

Mpika Diocese:Our Ladies Hospital (Chilonga) (started 1-1-2007), Chalabesa HC,(started 1-7-2008), Mulanga HC (started 1-7-2008)Ilondola HC (started 1-7-2008), Mulilansolo HC (started 1-1-2009),Health Desk (started 1-7-2008)

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P4P Evaluation

“He sent them to preach the Kingdom of God and heal the sick” Luke 9:2

•Evaluation was done in the 3 dioceses•Revealed both positive and negative outcomes •Recommended the involvement of a local stakeholder (CHAZ) in project management•Extensive involvement of the stakeholders in health•Identified a need for a pilot on proper PBF interventions •Use of a more contextualized approach in the design process

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The CHAZ PBF Pilot Project

• 2 districts selected for PBF piloting • Selection based on a set criteria• EU Funded PBF is a multi country project, • Pilot implemented in 3 years from Jan 2010 – Dec

2012

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Implementation strategiesSeven core strategies will be employed to implement the project:• Actual (co-)financing of (health) services based on past

performance, through the conclusion of service agreements for church health institutions

• Capacity building• Exchange visits and peer review• Action research• Site visits for monitoring purposes• Consultation at national, district and community level• Documentation and dissemination

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CHAZ INVOLVEMENT

• Following the recommendation for CHAZ involvement in P4P

• In July 2009 CHAZ studied the P4P situation and sensitized the stakeholders on PBF development

• Advocacy for PBF to all stakeholders • Developed institutional framework (WB, UNZA, MoH,

DHMT)• Shared PBF strategies with the TWG-MoH• TWG accepted the CHAZ PBF strategy• Selected districts shared with MoH

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Pilot District Selection Criteria• Rural district• Church presence (in view of Govt/FBO collaboration), in particular:

the number of hospitals and h/centres and share of churches’ catchment population as a % of total district population

• P4P history (with Cordaid)• Not an RBF district (intervention or control district) in the WB supported

project • Workload in terms of staff/contact ratio: preferably average (neither high nor

low)• Disease burden: child malnutrition (% underweight), pneumonia, %

institutional deliveries • Catchment population served by church health institutions: ideally not more

than 100,000.

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District Selection

Selection Cont’n

CHAZ /PBF Implementation StructureThe project emphasizes on split of responsibility• Fundholder Agency - CHAZ• Regulator – quality standards - DHMT• Local Purchasing Agency – responsible for contracting -

ZSIC• Local Verifier Organisation– client satisfaction surveys• Health facilities – DOPE and DAPP• Community organizations/committees – NHC, HCC,

HAC

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Verification procedure Quality• Done by local quality experts with performance contracts• Follow agreed upon quality standards • Give a score expressed in percentage• Quality will determine the absolute score (rewards =Quality*quantity*performance

index)

Quantity/data verification• Conducted by the LPA - ZSIC• Produces provisional invoices based on data results

Client Tracer surveys• Conducted by a locally based NGO – contracted• Results inform the next quarter business plans for the facility• In future, survey results will determine

Invoices• Are consolidated by the PBF district steering committee

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Where are we?

• Project design finalized• Actual implementation commenced in July, 2010• Baseline survey conducted• Desk review on existing levels of performance contracting in CHAZ• Performance verification for quarter three (2010) conducted• Project implementation manual• Capacity building activities for policy makers and implementers• Collaboration with other stakeholders - Trainers, LPA, Local verifier

organizations• Shared experiences with stakeholders in the country

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Selected Indicators/ costs

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Quarter 3 (2010) results

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“He sent them to preach the Kingdom of God and heal the sick” Luke 9:2

Sustainability plan for the CHAZ PBF scheme:

•Involvement of other critical stakeholders (Local purchaser,

Community organisations, MoH, UNZA)

•Member of the TWG-HCF and the PBF national steering committee

•Transparency about PBF-funding / Inequity

• Intergrated planning and reporting for PBF

• Community involvement – possible gradual intriduction of pre-

financing schemes

•Gradual intergration of PBF into the routine CHAZ program

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Thank you for your attention

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