Annual Results and Impact Evaluation Workshop for RBF - Day Two - Experience of Peer visit of PBF program in Chad
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The document reports on a peer visit assessing the Performance-Based Financing (PBF) program in Chad, focusing on various aspects such as health facility attendance, qualified personnel presence, and managerial autonomy. It includes preparations for the visit, methodologies employed, facilities visited, lessons learned, and suggestions for improvements. Conclusions highlight significant improvements in health center attendance and care quality, emphasizing the potential for further enhancements in the health system through the implementation of recommendations.
Annual Results and Impact Evaluation Workshop for RBF - Day Two - Experience of Peer visit of PBF program in Chad
- 1. Experience of peer visit of PBF program in Chad Cameroon Presentation
- 2. ToRs of the Peer Visit To document critically and constructively the implementationand immediate outcomesof the introduction of FBR in the Chadian health system. 1 ) Assess the attendance of health facilities in FBR compared to control ; 2) Evaluate the presence of qualified personnel in health facilities FBR ; 3 ) Compare the results of the external evaluation in the previous assessment of the PPA ; 4) Take a critical look at the managerial autonomy and how the funds generated through PBF and other sources ( cost recovery ) are managed ; 5) Appreciate how PBF averall best practices are implemented by the PPA
- 3. ToRs of the Peer Visit 6) Assess the perspective of users through their representatives (members of health committees ) in their consideration of the FBR ; 7) Assess the reports from the community based organizations; 8) Check the conformity of the implementation of PBF as compared to: (i) the planning that had been agreed with the Ministry of Health and the World Bank , and (ii) the PBF Manual of procedures ; 9) Assess PBF management tools ( indicators framework, scorecards reports, organization of health data evaluation tools, etc ....) ; 10) Evaluate the mechanism of capacity building to allow nationals to take over the management of PBF after the international PPA ;
- 4. Preparation • Before departure (at least 2 weeks): The teams exchanged by e-mail to develop the terms of reference of the mission; • On arrival Chad (for 2 days): Preparatory Meeting with the team MSP / national PBF team - Distribution of field teams (4 teams consisting of an expatriate and 1 national) - Review of the guidelines for the assessment • Upon arrival in the regions: Each team shall contact the Regional Representative, the Governor of the region to explain the objectives of the mission
- 5. Preparation (cont’) • Upon arrival in Districts: Contact with the District Medical team. Identification of centers to visit (PBF and non-PBF areas).. • In health centers: Introduce the objective of the mission to the staff, visit the structure, review documents (registers, record reporting, management tools, etc ...) • Facilities visited: 31 health centers, 11 DH, 1 RR, 12 EDC 4 ECDSR, 2 Sub-PAA (2 Leaders and 7 auditors), PPA (central). • At the end: Debriefing at each level before departure from the area. • At national level: presentation of general findings and recommendations
- 6. Preparation (cont’) What should the local team and PPA prepare for the visit: • Make available previous data (MIS reports, results of previous assessments by PPA, regulators, and local associations): • Documents such as: norms and standard (Staff, equipment, etc..), project management documents (manual of procedures, reporting form, contracts, index tools, etc.). • Logistics: Vehicle, driver, hotel booking, etc. ..
- 7. Lessons Learned for Cameroon • We have learned the concept of “Sub-PPA” that allows one PPA to cover a population of more than 1.6 million spread over a large area with large distances between the PPA and regions. Which for us is an economy of scale. • If the project was to extend in the coastal region, it is not necessary to create another PPA. We could just create branches in some health districts.
- 8. Suggestions to Chad Program • Train health centerstaff training and regulatorsto use the index toolsfor managingthe totalityof all their financial resources: • Respect the autonomyof management of centersand the Separationof Functions of different actors; • Amend contracts to align the contentwith principles of PBF Best practice; • Harmonize the criteria for validationof servicesdeclared and supervise the verificators • Take into account the results of the communityassessmentin the development of action plans and remunerationof health centers • We must start to identify the structure that must play the role of PPA after the departure of Aedes.
- 9. Conclusion • PBF is a reality in Chad. Just after 13 months of implementation, changes in the attendance of health centers, the quality of care and staff motivation is palpable where the pilot is implemented. • Potential for improvement of this project are enormous. The implementation of the recommendations above will improve the implementation of the FBR and its impact on the health system in Chad • Teams from Cameroon and CAR have also learned a lot from the experience of Chad