National Community Health Performance-based Financing: design and implementation of supply-side model

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National Community Health Performance-based
Financingdesign and implementation of
supply-side model

• PBF workshop Bujumbura February 16th, 2011
• Ludwig De Naeyer (MSH)

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Rwanda CPBF Interventions

• Second generation of PBF to address remaining
  barriers for achieving improved MCH outcomes and
  TB outcomes
• Choice and unit fee based on national priorities
  and expected quantities mainly for preventive
  activities
• CHW cooperatives receive incentives payment for
• Timely submission of quality SIScom reports
• Offer for 5 MCH-indicators and 2 TB-indicators

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Quantity Indicators (selection of SIScom)
Indicator Unit fee in dollar Applied unit fee in RWF
1. Nutrition Monitoring Number of children monitored for nutritional status (6 -59 mois) 3.24/12 RWF 150
2.ANC Number of women accompanied/referred to HC for prenatal care within first 4 months of pregnancy 2.24 RWF 10,000
3.Deliveries Number of women accompanied/referred to HC for assisted deliveries 2.73 RWF 13,000
4.FP Number new Family Planing users referred by CHWs for modern family planning methods 2.90 RWF 4,000
5.FP Number of regular users using long term methods (IUD, Norplant, Surgical/NSV contraception) 2.11 RWF 1,000
6.Nb of TB suspects examined referred by CHW 45 RWF 26,550
7.Nb of TB patients followed by CHW per month 51/6 RWF 5,000
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Cooperative performance and Reporting(quality
aspect)
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Cooperative Income 2009 (data WB/SPH)
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2010 CHW Cooperative Data
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Cooperative functioning (data WB/SPH)

• 47 of cooperatives and 38 of CHW charge patient
  fees

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2010 CHW Cooperative Data
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(No Transcript)
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Data validation and control

• Payment per unit reported so possibility of
  gaming
• Still mainly paper based
• Done by HC supervisor monthly
• External audits planned but not performed yet

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PBF-Payment for cooperative

• Quarterly via HC-account
• After validation of the data by sector steering
  committee (members are HC-head, the supervisor of
  the CHWs at the HC, the in charge of social
  affairs and a member of the civil society)
• Two parts
• Maximum amount for reporting depends on the
  target population of the cooperative. This is
  adjusted by the quality score.
• Productivity (i.e. offer services) unit fee
  Quantity
• First payment made for October November 2010
  average of 3700 for indicator and 900 for
  report
• Cooperatives use earnings for income generating
  activities and for dividend for CHWs.

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Cooperatives Reporting 97 for 2010 to date out
of 427 HC and Dispensaries
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Cooperative performance reports

• Started during the last quarter 2010 (n261)
• Average quality score 82

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Baseline data for Incentivized Indicators
Indicator Monthly Average per cooperative for October-November 2010
1. Nutrition Monitoring Number of children monitored for nutritional status (6 -59 mois) 1596
2.ANC Number of women accompanied/referred to HC for prenatal care within first 4 months of pregnancy 26
3.Deliveries Number of women accompanied/referred to HC for assisted deliveries 26
4.FP Number new Family Planing users referred by CHWs for modern family planning methods 39
5.FP Number of regular users using long term methods (IUD, Norplant, Surgical/NSV contraception) HMIS data
6.Nb of (TRUE) TB suspects examined referred by CHW Nl. HMIS data/ SIS 4
7.Nb of TB patients followed by CHW (total fee) 4
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Lessons learnt / challenges

• PBF incentives ensured rapid increase in SISCom
  reporting
• In the presence of a strong monitoring system PBF
  can be introduced for cooperatives to stimulate
  and reward activities of CHWs at community level.
  
• Quarterly payments are feasible and will
  hopefully lead to an increase of MCH and
  TB-activities. The results of this intervention
  will be assessed by an independent unit through
  an Impact Evaluation study.
• Data quality supervision and external audits
  still need to be introduced to verify data
  quality

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2010 CHW Cooperative Data

• In the past 12 months, how many times was
  performance assessed?
• Members (internal) 3.97
• Members (external) 1.18
• Cooperative (external) 0.52