Niger

Start: 2010
Phase: pilot phase
Estimate Coverage: 5%
Feasibility Score: 36%
Supported by: Ministry of Health; World Bank; KfW

A pilot PBF project took place in Niger in the Boboye Health District with World Bank funding. It produced a tangible improvement in the quality of care of the health facilities during the four trimesters of the contract, from 28% to 79%. The availability of drugs and other consumables improved and met the needs of the users. The cost of the project remained reasonable, which asserts that RBF can be efficient in producing good results.

Based on this pilot phase, the government with the support of the German Financial Cooperation (KFW) decided to include an RBF component in the design of a new project in Tillabéri region from where also the participants to the PBF course originate. The Reproductive Health Program (RHP) began its operations in May 2017. The RBF component of the project has a budget of US $ 6 million for a three-year period.

The feasibility scan carried out by the participants from Niger in Cotonou showed the following weaknesses in the design :

  • The feasibility score is 36% (while a minimum of 80% is required);
  • The KFW budget allocated can only cover a population of 521,000 inhabitants for three years on the basis of a costing of US $ 4.00 per person per year;
  • The free health care policy of the government (small children, delivery care and pregnancy care) is problematic due to the inadequate reimbursement rate of only 38%;
  • The health facility revenues from cost recovery for adults are transferred to a bank account managed by the district authorities instead of by the health facility and this money does not benefit the health facility and constitutes a demotivating factor for staff;
  • There is a mistrust among stakeholders about the free health care program in particular because the staff was already habituated to the cost recovery program that was introduced more than 20 years;
  • Several Ministry of Health officials doubt the wisdom of the integration of private and religious providers in the RBF contract system.
  • Central decision makers fear the separation of powers and autonomy of RBF, and they may prefer to centralize decision rights;
  • There is a single monopolistic national Central Medical Stores and the stock-outs of drugs at facility level are regular.

Recommendations:

  • Review the RBF program with the aim to achieve a score of at least 80%. This should include the granting of autonomy to the health facilities;
  • Advocate for the opening of PBF budget lines in the national budget;
  • Introduce a national technical PBF Unit with the personnel required for its operation;
  • Organize a roundtable meeting with the partners to mobilize fresh funds to ensure the financing of RBF in all district of Tillabéri Region;
  • Map the public, private and religious health facilities in the PBF areas and sign performance contracts with them;
  • Ensure the training of all actors involved in PBF;
  • Set up a PBF network in Niger.
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