Start: Preparation
Phase: 2019
Coverage Estimate: 30%
Feasibility: 92%
Supported by: World Bank

Description: 

The Togo government believes that PBF is an alternative for ensuring good quality of health service, efficient use of its resources, and financial access to care for the most vulnerable. The Cotonou group did an analysis of the feasibility score for the introduction of PBF in Togo and this showed a potential score of 92%. This encouraging score can be achieved if the action plan of the participants in Cotonou is implemented. This proposed the following derogations:

• Health facility managers should have the right to recruit and dismiss contract workers and have the right to refer non-performing civil servants back to the administration ;
• Authorize health facilities to set their cost recovery tariffs.
• Allow the health facilities to purchase inputs such as essential drugs from multiple distributors operating in competition.

Moreover, the team recommends to develop and sign performance contracts (using standard output and quality indicators) with the Directorates of the Ministry of Health and to transform existing government input budget lines into PBF performance subsidy budget lines.

The implementation of the PBF pilot is proposed to be done at the regional level with at least a target population of one million inhabitants for good economics of scale. For the first year, it is proposed to invest at least 3.5 million US dollars and increase the funding in the second year to 7 million US dollars. A baseline household operational survey with a control area is proposed to measure the effect of PBF.