Participants group 45

The 45th PBF course  in Cotonou took place from the 23rd of March to the 3rd of April 2015 with twenty-two participants from Niger (10x), Benin (5x), Cameroon (3x), Burkina Faso (3x) and Ivory Coast (1x ).

The participants appreciated the course with an average score of the daily evaluations of 85% compared to 79% for the 22 previous French courses. The satisfaction with the facilitation was 93%. Three participants received certificates of distinction, which means a score of 90% or more for the final test. These were for Dr Justin Kocou Djidonou from Benin; Dr Adama Sanon from Burkina Faso and; Dr Nestor YOUGBARE from Burkina Faso.

CONCLUSIONS for EACH of the PARTICIPATING COUNTRIES

Beach Cotonou

Niger will start PBF in the health district of Boboye in Dosso region with technical support from the World Bank, which will cover a population of 400,000.

Participants’ recommendations for Niger:

1. Authorities should apply all PBF best practices in the pilot project;
2. The course group will inform and create awareness about PBF among the administrative authorities, local elected officials, partners, etc ;
3. The project should establish a Regional Contract Development and Contracting Agency instead of a central one;
4. The project should conduct the mapping of public and private health facilities in the pilot area and sign contracts (primary and secondary) both with public and private health facilities;
5. Define the indicators for the community PBF activities.

Benin has performed reasonably well since 2012 with the pilot PBF programme by: (1) Improving the motivation of health staff; (2) Improving the professional quality of the health facilities; (3) Increasing the ownership for the peer group reviews among hospital staff; (4) By creating improved data availability at: http://www.beninfbr.org/  

Yet, the PBF program is not yet pure and the feasibility score is 58%.

Participants’ recommendations for Benin:

1. Avoid the accumulation of functions at the central level and create more checks and balances;
2. Health facility contracts should be signed by Regional Contract Development and Verification Agencies and not by the central level;
3. Maintain at least 95% coverage for immunisation activities at the health facility and;
4. Respect vaccines conservation standards at the health facility.

Burkina Faso started in 2010 a PBF pre-pilot in three health districts. The pilot was extended in 2014 towards 15 health districts covering with 4.2 million people 25% of the BF population. The results are satisfactory, but the feasibility scan score of 68% could still be improved.

Participants’ recommendations for Burkina Faso:

To the Ministry of Health: (1) Continue the expansion of PBF to all districts in the country; (2) Ensure the sustainability of the PBF strategy; (3) Ensure proper implementation of all PBF best practices.

To the partners: (1) Provide more funding for PBF; (2) Assist Burkina Faso towards the upscaling of PBF to all districts.

The Cameroon – Far North Region. 

The Cordaid funded PBF pilot started in January 2012 and has produced satisfactory results. The local Contract Development and Verification Agencies is the Association for the Promotion of Health in the Far North (APROSEN). The feasibility scan shows a score of 66%.

Participants’ recommendations for Cameroon:

1. Integrate the health facilities currently covered by Cordaid and APROSEN in the PAISS / World Bank PBF program;
2. Develop emergency PBF indicators to respond to the insecurity in the Far North caused by the Boko Haram insurgency;
3. Review and improve the PBF equity indicators to assist the vulnerable;
4. Take into account that the local CDV Agency (APROSEN) has already a good knowledge of the region.

Ivory Coast. The government and the World Bank plan to implement a PBF program for around 3.5 million inhabitants. Few private organizations in Ivory Coast are yet involved in the various PBF functions. To overcome this deficiency the Global Challenge Corporation organization offers its technical assistance.

The 44th PBF course finished the 13th of March 2015 in Douala.

There were 47 participants of which 14 from the Central African Republic and 33 from Cameroon. All participants passed the final test and there were 9 distinctions which implies a score of 90% or more. There were nine education sector participants from the Central African Republic.

The main recommendations of the course participants were the following:

• There is an urgent need to strengthen the PBF Unit in the Ministry of Health in Yaounde. They require to cement PBF in Cameroon by coordinating the different RBF programs such as PBF, voucher, value for results. The Unit should equally defend the PBF best practices and transform input budget lines into performance based financing budget lines. They should also monitor and verify the achievements and the performance payments of the regional CDV agencies.
• Assure the installation of robust contract development and verification (CDV) agencies. This requires setting clear terms of reference for a well-remunarated CDV staff with the autonomy to implement their tasks and without interferon from different input strategies;
• 

  Limbe beach

  Revisit the community PBF indicators and assure that only qualified health workers conduct curative patient care;

• Start the HGOPY tertiary hospital PBF program in all its departments;
• Conduct research on how to integrate the voucher system in the overall PBF health package indicators and thereby to reduce the administrative costs of the classical voucher system;
• Start as soon as possible the World Bank supported PBF program in 4 regions of the Central African Republic and change the current emergency general free health care policy into a targeted free health care for the vulnerable.
• Further strengthen the education PBF program in Central African Republic which considerably increase the money injections in the schools to assure quality and change the different input financing modalities of partners into results based performance payments.

The Freetown Beach is quiet due to Ebola

The 43rd PBF course finished in Sierra Leone at the 31st of January 2015. The course for 28 participants came exactly at the right moment when Sierra Leone also started reviewing its post-Ebola recovery program.

The current PBF “light” approach in Sierra Leone has achieved encouraging results. Yet, there are design problems and challenges such as the weak capacity to contract, verify and coach the health facilities and the unclear separation of functions in particular between regulation and contracting.

In line with the TOR the course participants conducted a review and feasibility scan of the current PBF system and proposed improvements for the next PBF PLUS phase.

Recommendations:

The 28 participants of the January PBF course in Sierra Leone

1. Strengthen the existing PBF system by applying best practices and instruments.
2. Increase the current annual budget of USD 3.2 million to USD 24 million per year. This would increase the current per capita PBF spending from USD 0.50 to USD 4.00 per capita (best practice) and hence also account for certain elements of the Free Health Care Initiative. This is not necessarily fresh finding but might also include the reallocation of existing input budget lines such as for essential drugs, equipment and infrastructure.
3. Contribute to health system strengthening in the post-Ebola recovery strategy.
4. Increase the quality of care through a whole set of quality improvement measures including performance incentives for the various functions in the health system.
5. To allow for efficient use (more value for money) and better coordination of available funds such as from the government, partners and private out-of-pocket expenditures.
6. Encourage good governance and increase the accountability through the separation of functions and improved verification & auditing mechanisms.
7. To strengthen public-private-partnerships at the providers level, organising CDV agencies and selecting local NGOs for community verification.
8. To strengthen the regulatory role of the Government of Sierra Leone through its MDAs and clearly defined relationships with the stakeholders (providers, community voice, verification agencies, payment agencies, partner organizations and civil society organisations).

We do not always see the same fact in the same manner?

Once the above recommendations are applied, international comparative experiences shows that the quality, efficiency and equity of the health services would greatly improve, and the system’s resilience in times of crisis hugely enhanced. It would restore the confidence of the population in the health system. Sierra Leone has the potential to become one of the PBF frontrunner countries in English-speaking Africa.

Participants 42nd PBF course

The 42nd PBF course ended in Mombasa at 12 December 2014 and hereby the report.

There were 25 participants. 14 from Nigeria, 3 from Uganda, 2 from Lesotho and Burundi and 1 from Malawi, Mozambique, Cameroon and Zambia.

21 participants were from the health sector but there was also 1 participant from the Local Government in Uganda, 1 from Civil Service Reform Commission in Malawi, 1 from the education sector in Burundi and 1 participant from the Cordaid loan section in Burundi.

The PBF journey is not always smooth

Studies published in November 2014  showed that PBF worked in Burundi. Yet, at the same time the studies also provide warnings that if the underlying best practices in PBF are not maintained that there will be no results. We learn from our colleagues in Burundi that there are still problems in the implementation of PBF with large delays in the payment of the subsidies, the essential drugs distribution system that still has monopolistic characteristics and the health facilities are less autonomous than desired.

PBF initiation of course participants

Problems in Lesotho concern the slow roll out of the project while the Uganda PBF program is still reviewing how the successful Jinja pilot can be scaled up. EGPAF Mozambique is doing well in Xai-Xai and Nampula provinces but they may need to improve its design so that it will create ownership and buy-in also from the government.

The representatives from the Local Government in Uganda and the Civil Service Reform Commission in Malawi propose to initiative new multi-sector PBF programs.

The PBF Journey continues – Shimba Hills Kenya

It has been a very exciting 2014 for SINA Health and its partners such as in particular the Kenyan, Cameroon and Lesotho governments, the World Bank, UNICEF, WHO, Cordaid, BEST-SD from Benin, BASP96 from Burkina Faso, the Littoral Regional Fund from Cameroon, HDP Rwanda and EGPAF Mozambique. There were during 2014 10 PBF courses with in total 284 participants including 25 participants that will attend the 42^nd PBF course starting the 1^st of December 2014 in Mombasa.

We would like to thank all participants for those memorable and stimulating discussions and moments in Mombasa Kenya Bay, Shimba Hills, Bobo Burkina Faso, Brazzaville, Cotonou and Ouida Benin, Kampala, etc. There were 54 participants with distinctions (20.8% of the total).

New PBF courses in 2015 are planned for:

• January 20-31, 2015 in Freetown for participants from Sierra Leone with Cordaid,
• Early March 2015 in Douala for the Cameroun government and the World Bank
• March 23 – April 4 in Cotonou Benin.
• Another English spoken course is planned for April – most likely in Mombasa.

PBF course in Bobo – Burkina Faso

One can also download the reports of the 40th PBF course in Cotonou (Rapport Cours PBF Cotonou V241014) and the 41st PBF course in Douala (Rapport du cours PBF Douala V261114).

These Cotonou and Douala reports contain fascinating information about PBF in Benin (doing well with scaling up and making the design more PBF pure) and Mali (starting up an improved pilot) as well as about Education in CAR (with good results) and the health program in Cameroon (scaling up from 4 to 7 regions) and the health program in the Central African Republic (successful implementation of PBF during the crisis).

The 1000th SINA Health course participant Nnenna IHEBUZOR

The Douala report also contains a protocol on which role PBF can play in Ebola prevention as well as how to strengthen the health systems during emergencies such as wars and natural disasters. The report also contains a questionnaire for a PBF quality review at primary schools and pre-schools.

The SINA Health team and its partners BEST –SD, BASP96, HDP Rwanda and the Regional Fund of Littoral Region wish the PBF family a very fruitful and successful 2015.