CARE. ACT. SHARE. LIKE CORDAID.
PBF IN THE
REPUBLIC OF
THE CONGO
DIFFERENT CONTEXT, SAME BUILDING BLOCKS
CARE. ACT. SHARE. LIKE CORDAID.
COOPERATION BETWEEN DIFFERENT ACTORS
PBF IN THE
REPUBLIC OF THE
CONGO
Ministère de la Santé
et de la Population
Programme de Développement
des Services de Santé - PDSS
CORDAID RBF
2 JULI 2013
Technical assistance, pilots or implementation in 13 countries
• Cameroun (impl.)
• Congo Brazzaville (impl.)
• Zimbabwe (impl.)
• South Sudan (impl.)
• RDC (pilot)
• Central African Republic (pilot)
• Uganda (pilot)
• Malawi (pilot)
• Burundi (TA)
• Sierra Leone (TA)
• Rwanda, Burundi and Congo SRH (impl.)
• Afghanistan
• Haiti
PROGRAM BACKGROUND
2 JULI 2013
• Start in January 2012 • Information meetings
• Manuel de produres (AAP)
• Opening of bank accounts
• First contracts in May 2012
• Startup grant paid
• Interruption from June to September 2012 • Facilities and regulator stopt using PBF instruments
• Cordaid temporarily closed sattelite offices
PROGRAM BACKGROUND
2 JULI 2013
• Restarted in October 2012 • New contracts signed
• First operational training
• Verification and validation
• Retrospective payments in November/December (also for Jan –May 2012)
CONTEXT
2 JULI 2013
• 3 regions (départements), 3 districts per region
• 73 Health Centers (CSI)
• 7 Hospitals
• 9 Circonscriptions Socio-Sanitaire (CSS)
• 3 Directions Départementales de la Santé (DDS)
• Sparsely populated
• Low utilization of services (average number of new consultations is
0,1 per capita)
SIX DIMENSIONS OF RBF
2 JULI 2013
Linking Payment
and results (indicators)
Contracting
Cycle from business
plan to verification
Autonomy (cash,
hire and fire etc)
Segregation of functions
Community
empowerment
(feedback, satisfaction)
Equity measures
LINKING PAYMENT AND RESULTS
2 JULI 2013
Shift from input to output, indicators, targets
• Target setting (163% coverage for vitamin A)
› Population correct? Calculation correct (10% of population in a setting with
much malnutrition)?
• Relatively good salaries for health staff.
› Doctors receive 1,000 USD per month
› Does the bonus payment of 60 USD make a difference?
• Some indicators (pregnant women completely vaccinated and distribution of
mosquito nets) deleted from the list because badly operationalized or
activities not performed
SEGREGATION OF FUNCTIONS
2 JULI 2013
Client
Agent
Principal
Problem
• Strong asymmetry
• Principle is not the client
• Property rights delegated to agent
• Agent prone to pursue self-interest
SEGREGATION OF FUNCTIONS
2 JULI 2013
Service Provider
Purchaser
Budget Principal
Qualit
y c
ontr
ol
Regulator
Client
SEGREGATION OF FUNCTIONS
2 JULI 2013
Challenges in Congo
• Regulator not capacitated to do supportive supervision (transport, knowledge, no medical staff trained in public health)
• Limited availability of trained staff also a problem for setting up purchasing agency. Specifically provide external technical assistance in startup phase (procurement, training, manuals etc)
• Crucial that purchaser is present at the lowest possible level (Satellite in Dolisie)
• Steering committee and technical committee at national level as well as a steering committee at department level; more regular meeting at national level necessary
• More reliable supervision, but still challenges in quality (organizational aspects, medical training, documentation)
• Peer evaluation
SEGREGATION OF FNCTIONS
2 JULI 2013
CONTRACTING
2 JULI 2013
From business plan to verification
• Clarifies, roles, responsibilities and expectations
• Not enough verification officers to accompany contracting cycles and do
supportive verification
• Low capacities (low number of staff with public health training)
• Capacities to apply operational instruments still limited
• Also, intensive support needed to understand procedures
• Continuous training necessary; people change jobs
COMMUNITY EMPOWERMENT
2 JULI 2013
Feedback, satisfaction surveys
• Community based organizations are contracted to verify existence of patients
• Challenges because of sparse population
• Patient satisfaction
AUTONOMY
2 JULI 2013
Cash payments, hire and fire, decentralised procurement
• Facilities paid “tax” to regulator. Has been abandoned and replaced by a
contract between the purchaser and the regulator for supervision
• Facilities in sparsely populated areas (2000/3000/4000 catchment area)
receive small RBF payments and have little room for improvement; bonus for
staff is lower as a result
• Facilities not allowed to hire staff. Distribution of staff not efficient. Now hired
informally and PBF payments used for this
• Limited availability of drugs (local stores not functioning; specifically HIV and
FP)
AUTONOMY
2 JULI 2013
AUTONOMY
2 JULI 2013
Cash payments, hire and fire, decentralised procurement
• Facilities not able to provide some services (only 3% of CSI offered TB
testing in 2012); more emphasis on training
• Limited operational knowledge regarding PBF: how to use instruments, do
planning, set priorities and write a business plan. For example, how to
calculate staff incentives?
• What has been done with subsidies?
• Incentives for staff
• Infrastructure (latrines etc)
• Medicines
• Motorcycles
EQUITY
2 JULI 2013
Isolation bonus, equity fund, vouchers
• A general 5% equity bonus is given to facilities
• Do facilities indeed setup equity funds? What is the role of the
COSA’s?
• Now one indicator for consultation for indigents
• How are indigents identified?
RESULTS
2 JULI 2013
Facilities offer more services
RESULTS
2 JULI 2013
Number of new consultations increased
3.827
5.810
6.823
9.418
7.521
8.403
-
1.000
2.000
3.000
4.000
5.000
6.000
7.000
8.000
9.000
10.000
DDS NIARI DDS PLATEAUX DDS POOL
Consultations Curatives 1er
Trimestre (oct.-déc. 2012)
Consultations Curatives 2ème
Trimestre (janv.-mars 2013)
RESULTS
2 JULI 2013
Number of children vaccinated
806
559 524
1057
736
1177
0
200
400
600
800
1000
1200
1400
DDS NIARI DDS PLATEAUX DDS POOL
Enfants complètement vaccinés
1er Trimestre (oct.-déc. 2012)
Enfants complètement vaccinés
2ème Trimestre (janv.-mars
2013)
RESULTS
2 JULI 2013
Number of deliveries in health centers increased
394
685
430
525
779
461
0
100
200
300
400
500
600
700
800
900
DDS NIARI DDS PLATEAUX DDS POOL
Accouchement eutocique assisté
1er Trimestre (oct.-déc. 2012)
Accouchement eutocique assisté
2ème Trimestre (janv.-mars 2013)
RESULTS
2 JULI 2013
Reliability of data improved (example inpatient days)
0
1000
2000
3000
4000
5000
6000
7000
8000
9000
10000
TRIM.1 de la 2ème Phase TRIM. 2 de la 2ème Phase
5520
9053
7119
9086
Données Vérifiées
Données Déclarées
RESULTS
2 JULI 2013
Number of supervision visits improved
RESULTS
2 JULI 2013
Quality score Pool
CARE. ACT. SHARE. LIKE
CORDAID.
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