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.

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

The course, which was attended by high-level participants, was a success and showed the value of PBF as a reform strategy to achieve Universal Health Coverage and how to target the vulnerable (Mauritania) and unstable areas (Mali, DRC, CAR). PBF can also be the steppingstone for introducing compulsory health insurance systems (Mali, Cote d’Ivoire).

Mali

The health status of the population is affected by several problems including insecurity, unequal distribution of qualified personnel and parallel financing systems from inside and outside the country. The PBF pilot projects were successful in improving the quality of services and in increasing the main service delivery activities. In addition, staff motivation has been improved and their retention in rural areas.

Recommendations for Mali

• Place particular emphasis on communication to ensure the visibility of the encouraging results achieved in the field by the PBF project through the media, etc.;
• Advocate for the mobilization of resources for the implementation of PBF;
• Adopt derogatory measures to enable the application of all PBF best practices pending the administrative and legislative reforms necessary for better mobilization of resources from the State and its partners for PBF;
• Speed up the finalization of the national PBF reforms as a sustainable strategy;
• Promote the signing of binary contracts at the level of health structures (between the verification agency and the in-charges of the health facilities) ;
• Advocate for the transformation of government budget lines (in input or cash) allocated to the health facilities into PBF funding;
• Conduct a study on the health human resources recruitment system with the aim to decentralise the powers of the health providers.

Mauritania

The PBF program in Mauritania covers 28% of the population and the results are very encouraging.

Recommendations for Mauritania

• Advocate with key actors to solve the problems of drug monopoly, price fixing of const-recovery fees and the non-integration of the private sector => i. Identify the key players; ii. Direct advocacy and; iii. Invite these actors to international PBF courses.
• Grant Quality Improvement Bonus for eligible health facilities;
• Activate the regional, district and health facility geographic equity bonus;
• Initiate cascade training on financial management for health facility managers.

 The Central African Republic

CAR started PBF since 2009 by the NGO Cordaid and has been expanded with programs funded by the European Union and the World Bank. In recent years, PBF has become the national reform strategy and around 50% of the country is covered.

Recommendations for the Central African Republic

• Liberalize the supply system for essential drugs in the health facilities so that the health facilities have access to multiple accredited wholesale distributors;
• Increase in the number of staff in quality and quantity in the health facilities through autonomous recruitment of qualified contract workers by the health facilities;
• Increase the number of staff within the national PBF unit with the aim to reduce the delay in the payment of subsidies.

Republic of Guinea-Bissau

Guinea Bissau is planning with the World Bank a pilot PBF approach and five participants from Guinea were the first to be trained in an international PBF course. The group gave a PBF feasibility score of the current situation of 20%, which is significantly lower than the score of 80% needed for a PBF approach that can be successful. However, the same group also thinks that with well-targeted advocacy, it will be possible to develop a PBF pilot project in the country that can achieve the required score of at least 80%.

Recommendations for Guinea-Bissau

• Prepare during 2023 a 2024-2027 PBF program for at least half of the population;
• Create a working group for the introduction of PBF in Guinea-Bissau.

Ivory Coast

In view of the convincing results, the Ivorian Government has opted for the extension of PBF nationwide in a context of generalization of Universal Health Coverage. The National PBF Unit has been attached to the Office of the Minister of Health since 2022. However, the particpants form Ivory Coast gave a PBF feasibility score of 40%, which means that it is still necessary to adopt several best PBF practices to guarantee success.

Recommendations for Ivory Coast

• Adopt PBF as health reform strategy also in the different health policy texts ;
• Organize international PBF courses for executives of the various key ministries;
• Experiment with a pilot project with the liberalization of the drug supply;
• Identify national structures that can perform the functions of contract development agencies (ACV in French) and external verification organisations (AVEI in French).
• Revise the costing of the PBF program and implement a plan to reduce the dependence on external donors;
• Ensure and obtain a waiver for the use of the revenues from cost recovery at the point of collection (similar to the Bamako Initiative);
• Revise the list of activities (indicators) to be purchased and integrate indicators on social marketing, the quality improvement bonus and for the vulnerable.

Democratic Republic of Congo

PBF in the DRC started in 2003 in the provinces of Kasai and South Kivu and gradually expanded to 39% of the population (26 million) in 11 provinces and 156 Health Districts. The contract development and verification agency PBF Sud Ubangi (ACV/EUP in French) verifies and certifies the quantitative and qualitative performances achieved by the service provider structures in the health sector or in any other sector.

Recommendations for DRC

• Sign sub-contracts between the principal contractors of the Health Centers with the subcontractors of Health Posts and private health facilities in their catchment areas ;
• Sign contracts between the ACV/EUP and all Reference Health Centers;
• Recruit staff autonomously through the health facilities;
• Stimulate competition in the drug market.

Benin

The course participants met with the staff of five health facilities during the field visit. The staff indicated to them that they regret the end of PBF in Benin in 2018. An adviser to the Minister of Health of Benin, Dr Rodrique Kohoun, who opened the course, explained that PBF best practices continue to play an important role in Benin, such as the principle of quality accreditation and the decentralization of human resource management.