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.
SPECIFIC COUNTRY SUMMARIES
- 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
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
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 ;
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
Dr. Inna RAKYA, Obstetrician Gynecologist HGOPED from Douala, Cameroon
Dr. Thaddée NDINDURWAHA, Public Health Physician CTN-PBF Ministry of Health in Burundi.
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).
RECOMMENDATIONS CONCERNING THE METHODOLOGY OF THE COURSE
- 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.