Category Archives: News

Final report of the 92nd PBF course of 27 November to 9 December 2023 in Cotonou, Benin

The next 93rd PBF course will be organized in Cotonou from April 22 to May 4, 2024. Here the course announcement (annonce cours 93) and course registration form (fiche d’inscription 93)

The last 92nd international PBF course took place at Benin Atlantic Beach Hotel in Cotonou, with 32 participants from three countries. Here the final report of the course (rapport final).

The 32 participants from Mali, Guinea-Bissau and Benin

The 16 participants from Mali were the largest group, including nine from the contract, development, and verification agency (CDV) Koulikoro, three District Medical Officers, three providers and one from the University. Among the 10 participants from Guinea-Bissau, there were two from the World Bank Project Implementation Unit and eight from the Ministry of Health. Benin was represented by five persons from the accounting firm COFIMA, and one person from MSV (Médecins sans Vacances).

Thirty-two participants took the post-test, and the average score was 71%, which meant an average improvement of 25% compared to the pre-test (46%). Nine participants earned a Certificate of Distinction with a score of 90% or higher on the course post-test. In addition, we congratulate Ms. Armelle Carine GABA, who obtained 100% for the final test.

Acrobats during the closing ceremony

This course was very well evaluated by the participants with the daily and final scores higher than previous French-speaking courses. This is probably linked to the fact that the majoirty of the participants self-financed their stay. The Benin Atlantic Beach Hotel was, this time, also better prepared to receive the participants compared to previoous courses.

This course was also historic in the PBF community, because we welcomed the 3000th participant since the first course in 2007. This was Jessica Vanessa da CUNHA, the social expert from the Bank’s Project Coordination Unit World in Guinea-Bissau. Continue reading

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The report of the 91st PBF course – organised in Benin

We have organized the first standard PBF course in 2023 in Cotonou, Benin. This was an open PBF course, the 91st since 2007 and the 16th in Benin.

It was organized between the 6th and the 18th of February, 2023. There were 18 participants from Tchad (15 x), Mali (2 x) and Benin (1 x).

Hereby the report of the course rapport du cours.

This course was well rated by the participants, with daily and final scores between 8 and 20 percent higher than previous French courses. This was probably because this group had only 18 participants, which facilitated the adult learning process whereby all participants could contribute to the discussions. The Benin Atlantic Beach Hotel was this time better prepared to host the participants compared to the December 2022 course.

The next 92nd open PBF course will take place from October 30th to November 10th, 2023 in Cotonou.

SUMMARY OF COURSE FINDINGS

Recommendations participants read on February 18 at the Closing Ceremony Continue reading

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The report of the 90th PBF course in Cotonou, Benin

We are very happy to announce that we have for the first time since 1999 organised another standard PBF course in Cotonou, Benin, which was open to any participant.

Fort Portugues

During 2021 and 2022 we organised seven PBF courses but they were only for participants from Tchad and Mali.

This course organised from 28th of November to the 10th of December, 2022 was the 90th course since 2007 and was the 15th in Benin since 2013.

Another PBF course (the 91st) was organised in February 2023.

Hereby the report of the course Rapport Finale du 90eme cours FBP de 28 nov au 10 déc 2022 Cotonou V24-12-22.

SUMMARY:

The 90th PBF course with 40 participants from six countries in Cotonou Continue reading

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The 83rd PBF course in Ndjamena – Tchad

The 33 participants of the course.

The first PBF course in Chad took place in the “Centre Etoile” in Ndjamena, with 33 participants coming from the central directorates of the MOH (12x), from the Inter-ministerial Coordination Unit for Universal Health Coverage (5x), INSEED (3x), Project Coordination Unit (UCP) Redisse (5x) and two national NGOs (2x). Representatives of the Ministry of Finance and Budget (5x) and the Ministry of Planning (1x) were also present.

31 participants took the post-test, and four participants obtained a certificate of distinction with a score of 80% or more for the final test of the course, which were Mr. ASSEMAL Alfred, Responsible for monitoring and evaluation of UCP REDISSE; Dr SODJE Hinberka, from the NGO Alerte Santé ; Mr. GOUH PINABEY Nathaniel, from INSEED; Dr NEHOULNE Gaston, from the MSPSN.

The PBF programme 2022-2025 in Chad and its preparations

The results of previous PBF programs showed improvements in some indicators such as for assisted deliveries, children fully immunised and the quality of care. The government of Chad and the World Bank agreed in 2021 on a new project called the “Health System Performance Strengthening Project” (PRPSS), which will cover all districts in eight provinces. The duration of the project is 4 years. The population covered is 6.7 million inhabitants out of 13.2 million inhabitants of the country, or about 51% of the total population. The amount of funding is $ 106.5 million over 4 years.

Preparatory activities are underway, namely the establishment of the PBF Unit (CTN-FBP in French) and the Contract Development and Verification Agencies (ACV in French). The effective start is scheduled for January 2022. For the preparation of the program, the government organises five international PBF courses. These courses are also used for the training of national facilitators, who will then train the different actors of health facilities, provincial and district regulatory authorities as well as other key actors.

Achievements of the PBF program in Chad

  • The PBF program is relatively pure in terms of applying the PBF best practices.
  • There is willingness adopt the PBF reforms within the government and among development partners.
  • Nine working groups developed excellent action plans during the PBF course which, if implemented, will greatly improve the health system in Chad.

Problems identified by participants concerning the PBF pogram

  • Health facilities have insufficient infrastructure and equipment
  • A study of 17 tracer products showed that on average, a health facility has 7 of the 17 products => availability rate 44%. This is caused by the “input” financing approach with centralized purchasing of inputs for the health system. The consequence is an inefficient distribution of equipment and drugs with an unused surplus in some HFs, and a shortage in other HFs.
  • Some policymakers may be reluctant to accept the change from central “input” financing towards direct results-based financing of the health facilities because they may lose certain benefits linked to input financing
  • The members of the Health Committees in Chad play a very important role in the day-to-day management of the health facilities including the signing of contracts and bank checks. However, in PBF best practice, the day-to-day management should be done by the permanent members of the HFs (in-charge with his team) This to avoid late payments and the risk that Health Committee members only sign when they receive “something” in return.
  • The performance contracts in Chad are signed by several actors instead of just two. This poses problems because with three or more signatories it is no longer clear who is responsible, which can create confusion.
  • Poor management of human resources and the presence of unqualified staff. There is an unequitable distribution of health workers in rural and urban health facilities. Waek knowledge and skills of health staff
  • There are not yet PBF budget lines in the Finance Law. This may be caused by a lack of clarity regarding the financial and legal procedures required to disburse the government budget through payments directly to peripheral providers and to the population.
  • The functioning of the current HMIS is not optimal at all levels of the health pyramid.
  • In the previous PBF pilot program, paper invoices for all HFs in the country were centralized at Ndjamena level.

The 33 participants of the PBF course

Recommendations

  • Make wider use of the quality improvement bonuses to correct the problems related to poor infrastructure and the lack of equipment
  • Allow the health facilities in the 8 PBF provinces to buy essential drugs, consumables and equipment from accredited distributors operating in competition
  • Authorize the Central Pharmaceutical Agency to supply drugs to private health facilities.
  • Offer performance contracts to all units and departments of the ministries of health and finance, which allows them to obtain competitive remuneration.
  • Most participants (79%) said it would be better if the day-to-day management will be done by permanent HF managers, including the signing of bank checks, and managing drugs. However, they also proposed to get the opinions of the participants of the next course who are closer to the field.
  • Performance contracts should be signed between two entities (= binomes). Thus, for Chad, it is proposed that the HF contracts be signed between the Head of the Health Center (RCS) and the CDV (ACV) coordinator.
  • Advocate at Ministry of Civil Servants and the Ministry of Finance and Budget to decentralize human resources management, supporting according to the regulations in force and increase the PBF subsidies for the decentralized recruitment of contractual staff.
  • On the job training and supportive supervision
  • Study the possibility of transforming the government budget lines “crédits délégués” into “PBF” budget lines.
  • Advocate for the operationalization of DHIS2
  • Archive the paper PBF HF invoices at decentralized level. This recommendation means that HFs and the CDV Agency (ACV) each file copies of the PBF invoices. The CDV Agency also maintains the data in an EXCEL file and enters the data into DHIS2.
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Recommendations for 6 countries from the 82nd PBF course in Cotonou

All participants successfully passed the post-test ! Congratulations

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.

Image de temple de pitons de Ouidah

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.

Continue reading

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