The last FBP course of 2019 took place in Cotonou from December 2 to 14, 2019 with 32 participants from six countries (Mali, Comoros, Gabon, Mali, Niger, DRC and CAR). Eight groups (three groups from CAR) developed excellent action plans, which, if they are implemented, will greatly advance PBF in the respective countries and sectors.
Here the detailed report of the course (rapport).
STATUS OF PBF IN THE COUNTRIES AND SECTORS WITH MAIN MESSAGES:
- In the CENTRAL AFRICAN REPUBLIC around 50% of the population is covered with PBF, and the government decided to roll out to 100% the reforms nationwide by the end of 2020 with funding from the government, the World Bank and the European Union. NGOs such as Premiere Urgence Internationale – which attended the Cotonou course – may also start playing an active role. In the DEMOCRATIC REPUBLIC OF CONGO, the PBF reforms are progressing well and 40% of the population is covered by PBF. The designs in CAR and DRC are relatively “pure” in terms of the application of the PBF best practices. However, the participants from these two countries in Cotonou also propose several improvements in the design.
- In the COMOROS, 50% of the country is covered with PBF and the country is proposing to scale up in 2021 towards a “purer” PBF design compared to the current one. The six participants in Cotonou in their action plan proposed several improvements in the design and will advocate for a larger ownership for PBF among key decision makers.
- In GABON, the planning for performance-based financing started in early 2017 with Gabonese funding, but implementation has not yet started. This may be due to a lack of clarity on the financial procedures and willingness by government to provide the funds. The Ministry of Finance in Gabon aims to launch a pilot PBF program and could also help the Ministry of Health to progress with PBF.
- MALI has experienced long delays in starting the scale up of PBF despite that two pilot projects have shown excellent results. Yet, the Mali government with support of the World Bank, the Dutch government and GFF now aim to start a large relatively “pure” PBF pilot in 2020 for 5.8 million people and a budget of $ 66 million for four years. A large team of 14 people from Mali was in Cotonou to improve the design of the program.
- NIGER also experienced long delays in starting the scaling up of PBF despite that the pilot project has shown excellent results. The reasons for the delays are: 1. A lack of ownership for PBF by the decision-makers. PBF remained in the “project mode”; 2. Delays in the effective integration of the National Technical PBF Unit in the Ministry of Health; 3. Errors in the design of the PBF program. The Niger participants in Cotonou aim to revive PBF with the start of a large pilot programme.
- In the Central African Republic, the MINISTRIES OF JUSTICE AND THE INTERIOR with support of Cordaid aim to launch a PBF program. Experience in other countries with PBF in these sectors such as in the DRC have shown good results.
A problem in many countries is that PBF budget lines are not effectively integrated in the government budget and Finance Law procedures.
There may be a lack of clarity regarding the financial and legal procedures required to disburse the government budget through performance payments directly towards peripheral providers and the population instead of through the classical complex input procedures
A further general problem is that in several countries some decision-makers are hesitant to transform the less-transparent input financing into results-based funding, which transmits money directly to providers and the population. The latter approach is more transparent and less likely to lead to corruption. The best way to remedy this is to offer performance contracts to the main actors and departments of the ministries of health and finance. This should enable them to obtain a competitive remuneration adequate to only defend the public interest instead of earning money through shady deals.