The opportunities for PBF in the DR of Congo

The 60 participants of the 75th PBF  course with theSecretary-General

The 75th  International PBF Course took place from 8 to 20 October 2018 in Kinshasa in the Democratic Republic of Congo, bringing together 60 participants from the central level.

Hereby the report of the course (rapport)

The health status of the population in DRC is not well. Maternal mortality and malnutrition rates are high.  There are multiple problems in reproductive health such as complications and consequences of early and unwanted pregnancies. It is further aggravated by the occurrence of pregnancies that are too close together due to the low contraceptive prevalence of 8%. There is still no convincing strategy for involving the private sector in the health system. Continue reading

New developments with results-based financing in Guinea

The 47 participants with the Minister of Health

The 74th International RBF course was held in Coyah in Guinea from the 10th to the 22nd of September 2018. There were 43 government participants from the central, regional and district levels, three representatives of partners organizations and one representative from the private sector.

The impact of the 74th RBF course has been reflected in the good quality of the group action plans (see rapport). The average pretest score was 32% and the post-test score was 62%  which means a 30% improvement. Three participants obtained a favorable mention for their final test with a score of 83% : Dr. Ahmed Sekou Tidiane BARRY of the Ministry of Health – DNESH ; Dr Moussa SOUMAH                                 of the Ministry of Health – SNAS and ; Dr. Houssainatou BAH from the District Health Directorate Dubreka. Continue reading

PBF in Mauretania, Togo, Djibouti, CAR and Guinea

The 33 participants of the PBF course in Cotonou

The 69th PBF course took place in Cotonou from 18 to 30 January 2018 with 33 participants from Djibouti (12x), Togo (11x), Mauretania (7x), CAR (2x), and Guinea Conakry (1).

The impact of the 69th PBF course has been translated into the good quality of the action plans produced by the country groups. The course facilitation team is experienced because they come from several countries (DRC, Benin, Burkina Faso, Netherlands) and also work in several countries. In addition, the CAR and Guinea Conakry delegations came with practical experiences on PBF from their countries. This helped other participants to better understand the realities and experiences of PBF around the world.

Five participants obtained a certificate of distinction with a score of 90% or higher for the end-of-training test. They were three from Mauretania, one from Togo and one from Guinea :

Summary of the recommendations of each country

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Recommendations for Nigeria, The Gambia, Ethiopia and Zambia

The 31 participants in Mombasa with the facilitation team

The 70thperformance-based financing (PBF) course took place from Monday, May 28 to Friday, June 8, 2018, in Mombasa, Kenya. Thirty-one participants attended the course: 16 participants from Nigeria, 6 from Zambia, 5 from Ethiopia, 3 from The Gambia and 1 from the USA.

Hereby the detailed course report.

The groups analyzed their health systems and produced detailed action plans on how to advance PBF in their respective countries, states, and regions. Thirty participants conducted the final exam and achieved an average score of 70%, including three distinctions.

The “Village 70” authorities consisted of the Village Chief, Dr. Abba Zakari UMAR; the Deputy Village Chief Mr. Mannix NGABWE; the Time Keeper Dr. Halima ABATE; and the tax collector Mrs. Makasa NONDE. The energizers were Mr. Ensa Jarju, Dr. Baba, Mrs. Sharon, Dr. Abubakar and  Dr. Tijjani. They actively supported the facilitation process and contributed to a congenial atmosphere while maintaining “order” in the village.

The daily evaluations resulted in scores which were comparable to previous English spoken courses. The final evaluation indicated that the participants felt the content of the course to relate well to their regular professional activities. The participants were also satisfied with the methodology and the organization. The contents of the course modules were appreciated with much higher scores compared to the previous courses. Some participants commented that facilitators should avoid dogmatism and acknowledge that context-specific issues are important. The issue of respect for country-specific characteristics is fully recognized. At the same time, we deem open and comparative debate in an international forum which stimulates some out-of-the-box thinking also a vital characteristic of the course.

The course was organized around a strong core of ‘developing individual and country action plans’. This conscious focus was started a few years ago and with each course, more attention is given to the action plans. We are planning to advance in this way of going about the course and deepen the quality of the individual or group action plans each time and building the 17-course modules around this core task.

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Recommendations 71st PBF course Douala

The 32 participants with the authorities of Douala Town

The 71stInternational PBF Course was held in Makepe Palace Hotel in Douala from 7 to 19 May 2018. Thirty-two participants attended the course with six facilitators and three dedicated staff at the Secretariat. Three participants were from the Central African Republic and twenty-nine from Cameroon. The average score of the 32 participants who took the final exam was 75% which is slightly higher than the previous test results of the PBF courses. Three participants were awarded the certificate of distinction.

Hereby the detailed course report rapport du cours.

Positive aspects of the course

The daily course evaluations by the participants were good. Also at the closing of the course, we received positive feedback from several participants on the content and methodology of the course.

The quality of the action plans was better compared to previous courses because there was more time for the participants to work on them supported by coaching by the facilitators during the late afternoons and evenings. In particular, the action plans of the Division of Cooperation (DCOOP), the General Inspectorate of Medical and Paramedical Services, the National Malaria Control Program, the Regional Funds for Health Promotion and the General Directorate of the Ministry of Health from the Central African Republic were of a high standard.

The Makepe Hotel was rated better by the participants compared to previous courses. The hotel has invested in improving the rooms and the conference center. Food services were considered satisfactorily.

Aspects of the course that require improvements

Turning Point Question

During the final evaluation of the course, 30% of participants said that “the objectives of the seminar were not related to their professional activities”. We did not really understand this feedback but it could be linked to the fact that some directorates and programs are not yet fully engaged in the PBF program.

The duration of the course was considered too short for 39% of the participants; which means that despite the extra Saturday it is still difficult to share the main elements of the course within 14 days.

There were printing errors in the course book whereby some lines at the bottom of the pages were not visible and some tables and figures were fussy.

General recommendations of the course participants to the Ministry of Health

  • Restitution of the PBF course recommendations in the respective workplaces including in CAR (all participants);
  • Start PBF contracts with the Directorates and Programmes, which are not yet enrolled (all participants)
  • Introduce PBF in the course curriculum of medical training schools, nursing schools, ENAM, etc (all participants)
  • Harmonize the tax laws for both public and private health facilities and create an equal playing field (DRFP with MINFI)
  • Advocate with the Ministry for a more rational division of the health districts (DOSTS / DRSP / DMOs / CIS)
  • Advocate that training schools select and train students to become health entrepreneurs capable of advancing PBF best practices and innovation (all participants)
  • Integrate the PBF quality reviews and accreditation in the work of the Inspectorates of the Ministry of Health (IG with support PBF Unit)
  • Disseminate the circular of October 2017 of the Ministers of Health and Finance circular on the financial management of health facilities in Cameroon and make sure the new procedures are implemented (IGSA / PBF Unit)
  • Develop or update the current laws  and procedures of the Ministry of Health to support the PBF reforms (IGSA / DAJC / DCOOP)
  • Review the community verification interviews by local NGOs and make sure that they abide by ethical standards such as confidentiality (PBF Unit, CDV Agencies, DOST)
  • Put the municipalities under performance contracts to assist with the PBF community activities such as household visits (PBF Unit)
  • Assure that there is sufficient funding for supplementary feeding indictors in the nutrition whereby health facilities buy the required inputs  (Directorate of Health Promotion)
  • Add more information at the PBF / HMIS portal such as health facility revenues and number of qualified personnel (CDV Agencies, PBF Unit, CIS)
  • Disseminate the national PBF manual towards all contracted structures (PBF Unit / Regional Directorates / DMOs)

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