Messages from Nigeria, Liberia, CAR and South Sudan

The 80th international PBF course organised by SINA health in Mombasa-Kenya in November 2019, welcomed 37 participants from Nigeria 19; Liberia 16; South Sudan 1; and CAR 1. Most were from the health sector. Hereby the detailed course report.

This course was evaluated by the participants as one of the best since 2007. The criteria methods and facilitation, participation and organisation scored very well with averages of respectively 95% 93%, and 94%. The final evaluation indicated that for 100% of the participants the content of the course related well to their professional activities and that the methodology of the course was excellent. Yet, 50% of the course participants also commented that the course was too short. Continue reading

The 80th PBF course in Cotonou with messages from 10 countries

The 39 participants to the PBF course in Cotonou

The 80th FBP course took place in Cotonou from June 17 to 29, 2019 with 39 participants with 10 countries represented. Hereby the detailed course report.


  • We report that in Burundi, Gabon, Mauritania, Ivory Coast, Cameroun, the Democratic Republic of Congo and the Central African Republic performance-based financing is advancing well.
  • Yet, delays of subsidy payments in Cameroon caused by factors not related to PBF has created serious problems.
  • There are prolonged delays in the scale up of PBF in Guinea Conakry and Madagascar and efforts to restart PBF in Benin have not yet been successful.
  • Yet, overall, when reviewing the results from these 10 countries, the balance is positive. Lessons learned are becoming available both from positive experiences but also from mistakes made.

The PBF course was successful in exchanging the above experiences and all the participants from in total 11 groups developed excellent action plans that are likely to advance PBF in the 10 countries represented.


    • Burundi. PBF is national policy since 2009 and it has done well also under difficult political circumstances. The participants propose to update the national PBF manual and to introduce the quality improvement bonus system to accelerate investments in rehabilitation, equipment, human resources and equity indicators. These changes may require an increase in the annual per capita PBF budget. Participants also suggested that government should allow more competition for health facilities to purchase their inputs from distributors operating in competition. Another proposed change is to create an independent legal status for the Provincial Committee of Verification and Validation (CPPV), well-separated from the provincial health authorities ;
    • The Cameroon Ministry of Education started PBF in 2017 and wish to upscale it to 3000 schools during the coming years. Yet, the feasibility score is only 48% and there is a need to review the design and the costing including for the introduction of the quality improvement bonuses.
    • Education in the Central African Republic: PBF in the education sector in CAR has been piloted

       Participants with facilitators

      with good results for several years by the Dutch NGO Cordaid. Course participants propose to strengthen PBF by involving the technical and financial partners and also using the state budget. There is a great shortage of qualified teachers in CAR, especially in rural areas, and a lack of investment in infrastructure, equipment and school materials. The PBF approach of developing contracts with autonomous government- and private schools should fill this investment gap and motivate teachers to provide quality education. It is also necessary to revise the PBF program and to establish a detailed costing of the primary education package and to carefully plan the sources of funding from the government as well as partners.

    • Cameroon : Gynaeco-Obstetrics and Paediatric Hospital of Douala : Start PBF in the hospital according to the same approach as in the HGOPY hospital in Yaoundé, launch a pilot phase and train staff in PBF ;
    • Ivory Coast: The participant proposes that government should recruit an external and independent counter-verification agency. This agency should also work with the inspectors of the ministry of health to reduce counter-verification costs and to create synergies with already existing structures ;
    • Gabon : Budget programming by objectives has been the national policy since a few years but lacked the implementation instruments to make it operational. The PBF approach can provide the conceptual framework and the instruments. The participants of the course propose to pilot the PBF approach in 10 accounting posts of the public treasury with the possible national scale up in 2021. This also requires a budget to finance the performance contracts and to create a contracting and verification agency.
    • Guinea Conakry : Partner organisations carried out a successful pilot in Mamou region and

       Case de python in Ouidah

      government plans since a few years to start a pilot PBF program for 2-4 million inhabitants. For this purpose, it created in 2019 the national PBF Unit that proposes to start the contracting process with independent regional contract development and verification agencies under the umbrella of the regional coordination services (SERACCO). Yet, the PBF manual still needs to be finalized and health facilities should be allowed autonomous management. There is a need to increase the PBF budget for the pilot districts to at least $ 4.00 per person per year. The private sector facilities, which are dominant in particular in (semi)urban areas, should also be contracted through the PBF approach.

  • Madagascar: This country has been considering a large PBF pilot since a couple of years, but there have been repeated delays in its implementation. Moreover, the participants to the Cotonou course also detected design problems. Their main proposal is to increase the funding from the current $ 1 per person per year towards $ 4. Health facilities should also be authorized to buy their inputs from other suppliers than only the central medical stores. The PBF manual could still be revised based whereby the manual from the DRC and Cameroon could serve as inspiration as well as elements of the FBP course manual.
  • Mauritania: The PBF program in this country has started in two regions for a population of 620.000 people with a third region still to be added during 2019. The results are encouraging but there are still a number of design and operational problems. The participants propose that government should develop a circular that contains the exemptions required to apply the best practices and procedures of the FBR manual and establish contracts with the central directorates and the general health inspectorate ;
  • Democratic Republic of Congo: The course participant proposes that Caritas Congo should play the role of fiduciary agency to facilitate financial transactions in disadvantaged regions of the DRC and to play de role of microfinance institution ;
  • Benin : Conduct a feasibility study with independent experts and decision-makers for the restart of the RBF program. The objective should also be to strengthen the national ARCH policy, which includes health insurance ;


Poster presentation action plan of country groups

This FBP course took place in Cotonou from June 17 to 29, 2019 with 39 participants from ten countries: Mauritania (12x), Burundi (9x), CAR (4x), Guinea Conakry (4x), Madagascar (2x), Cameroon ( 2x), Gabon (2x), Benin (2x), DRC (1x) and Ivory Coast (1x). There were participants from the health-, education- and public treasury sectors, who attended.

Thirty-nine participants did the posttest and the average score was 70%, which meant an average increase compare to the pre-test of 23%. Two (2) participants obtained a certificate of participation and five (5) obtained a certificate of distinction with a score of 87% or more for the final test of the course.

The following participants obtained distinctions :

With 87% :

Dr.Jean Marie NTIBAZOMUMPA, Public Health Physician of SIS – MSPLS in Burundi

Mr. Nicolas BEYEME-NGUEMA, Inspector of Finance, Public Treasury in Gabon

Dr. Mathieu BIKOKO – EYALAMPUM,Public Health Physician of Caritas DRC

With 90%:

Dr. Inna RAKYA, Obstetrician Gynecologist HGOPED from Douala, Cameroon

With 93%:

Dr. Thaddée NDINDURWAHA, Public Health Physician CTN-PBF Ministry of Health in Burundi.


  Drinking coconut milk in Ouidah

The participants gave for the daily assessments of the course an average score of 77%, which was slightly below the average of the 45 previous French-spoken courses. During the final evaluation the participants gave a 90% score for the preparation and the general impression of the course. They thought that the organization was good except for the quality of the hotel with 46% and the food with only 38%. The open mindedness of the facilitators was evaluated at 100%. The majority of the modules were evaluated satisfactorily except for the economics module (51%). The impact of the 80th PBF course was reflected in the good quality of the action plans implemented by the country groups (see the rest of this report).


  • Develop a PBF course adapted only for the education sector with fully adapted modules ;
  • Methodology of the course: Review the modules of economics and health economics so that participants understand it better ;
  • PBF feasibility score methodology: Add a criterion that takes into account in how far that there are timely subsidy payments in countries that already implement PBF.
  • Disciplinary measures of the villagethrough the minister of finance, the village chief and the shepherd during the PBF course were appreciated and contributed to the sincerity and discipline of the debates and this methodology should be further developed ;
  • The “question-and-answer”methodology in PowerPoint animation worked out well as innovation because participants better focus on the questions asked instead of passively reading the PowerPoints statements.

77th cours, financial procedures and emergency PBF

The 77th performance-based financing (PBF) course took place from Monday, May 13 to Saturday May 25, 2019.  Hereby the course report

                    The 51 participants of the 77th PBF course

The course welcomed a mixed group of 51 participants from the Ministry of Health, the Ministry of Finance, the National Civil Status Registration Office, the Ministry of Economy, Planning & Regional Development, and the Governors’ office of the West Region. All participants conducted the final exam. The overall score of the final test was 70% and eight participants obtained distinctions for their final exam with scores of 87% or more.

The status of PBF in Cameroon

By the end of 2019, 100% of the Cameroun population will be covered by performance-based financing and will be 10th low or middle income country to achieve this. 100% of the 2.7 million town of Douala is now under PBF with 80-90% of the contracts given to the private sector. Continue reading

National PBF scale-up in Cameroon – the 76th course

       We report on the PBF course, which took place in Douala from April 22 to May 4, 2019 with 58 participants from Cameroon. Hereby the detailed cours report (rapport du cours)

The 58 participants of the cours with national and regional authorities

This time there was a large delegation of 13 people from the Ministry of Finance with 8 financial controllers and 5 Treasurers General of Payments (TPG) from 6 regions. There were 8 economic and social advisors of the governors from 8 regions. The Ministry of Planning and the Department of Civil Registration (BUNEC) were represented and there were two independent participants. All other participants were from the health sector

The daily evaluations of the course showed an average score of 80%, which is 1 point higher than the average of the 44 previous French courses. The impact of the 76th PBF course was reflected in the good quality of the action plans proposed by the different groups and the general recommendations (see the rest of this report).

Fifty-nine participants (including one participant from BUNEC, who assisted as an observer) did the post-test and the average progression from the pre-test was 29%. The average post-test score was 68%, which is 4% lower than the 72% average of the last 20 courses. Nine participants obtained a certificate of distinction with a score of 87% or higher for the final course test. Six participants obtained a certificate of participation with scores of 50% or less.

The achievements of PBF in Cameroon

  • Towards the end of 2018, performance-based financing in Cameroon covered 78% of the population and it will reach 100% during 2019 ;
  • The liberalization of the pharmaceutical sector with the accreditation of pharmacies by the regulators has started to produce the results on improving the availability of medicines in certain regions such Littoral. This liberalization has also resulted in the increase of the health facility revenue rather than that these revenues benefit some monopolistic distributors. The health authorities in Littoral Region accredited 10 wholesale distributors in Douala and the other regions started the same accreditation process.
  • The contracting of the regional and district health authorities produces good results. It better focuses the authorities towards achieving their core activities such as quality control and accreditation of the health facilities and pharmacies. This for most authorities is a welcome move away from wasting their time on the inefficiencies that existed in the old system of input procedures without a clear vision or objectives ;
  • A health centre in the North region before PBF rehabilitation

    As an example of the positive effects of PBF for the availability of qualified staff in remote areas, Ngong and Guider health districts in the Northern Region reported an increase in the number of qualified personnel by 98% from 55 to 109 between 2017 and 2019. PBF has a positive impact on the migration of qualified personnel to vulnerable PBF health facilities.

  • Numerous PBF infrastructure improvements have been made as shown by the following images, pre- and post of Guider Health District in the Northern Region.

Continue reading

Ethiopia, Nigeria, Cameroon, CAR and the Netherlands? The 78th PBF course

Le résumé en français du rapport est présenté en bas

The next English-spoken PBF course will be in Mombasa ftom the 28th of October to the 9th of November, 2019.

This 78th performance-based financing (PBF) course took place from Monday, April 1st to Saturday, April 13th  2019, in Mombasa, Kenya. Twenty-six participants attended the course: 14 from Nigeria, 7 from Ethiopia, 2 from Cameroon and 2 from the Netherlands. 

Hereby the course report.

The Nigeria team consisted of fourteen participants, from the Ministries of Health in Adamawa, Borno, Kebbi, Kwara, Nasarawa, Ondo and Yobe States. The Ethiopia teams consisted of three participants from the Ministry of Health at federal level and four from a PBF pilot in Borona Zone in Oromia regionThe two participants from Cameroon were from the North West region. We welcomed one participant from CAR and two from The Netherlands – one working at CORDAID head office in The Hague, and the other a senior general practitioner in Holland.

The “Village 78” authorities consisted of the Village Chief, Dr. Omar IBRAHIM; the Deputy Village Chief, Flora KWIZERA; the time keeper, Buzinel Gudisa Mijena; the Finance Ministers, Kinyuy Margaret Gham and Kees Melcherts and the EnergizersBaba Laminu, Abubakar Abana and Mekdelawit Mengesha.

They actively supported the facilitation process and contributed to a congenial atmosphere while maintaining “order” in the village.

Evaluation of the course venue and the course

Twenty-six participants conducted the final exam. The average test score result was 67% with six certificates of distinction and six certificates of attendance.

This was the third course in the 4-star Traveller’s Hotel, which provided a professional and pleasant ambiance. This justified the higher full board tuition fee.

The daily evaluations yielded scores, which were with 85%, 1,6% above the previous 24 English courses and 6% above the previous French-spoken course. Methods and facilitation scored 87,5% (the same as the previous courses). Participation scored 87.2% (the same as the previous courses). Organization scored 86.6% (0,3% above the average of the previous courses). The subject of timekeeping scored 78,8% (6,2% above the average of the previous courses).

The final evaluation indicated that for 88% of the participants the content of the course related well to their regular professional activities. Yet, only 52% said that they were well-informed in advance about the course and some indicated that the course book should have been distributed 1-2 weeks in advance of the course. The fact that some participants’ names were only known a week before the commencement of the course contributed to this score. Participants were satisfied with the methodology and the organization. In October 2018 a large proportion of 43% of participants thought the course to be too short and nobody thought that the course was too long. This course we added one day (the Saturday) to the course duration and this worked better to reduce the time pressure to finalise the action plans as well as the course modules.


Central African Republic Security and Justice Sector Continue reading