Gabon aims to start in early 2018 a new PBF program that will cover a substantial number of regions. Preparations are still under way with the government and the World Bank about the size and the scope of the program. A particularity of this PBF program is that it aims to integrate and strengthen the existing obligatory insurance program, which is suffering from cost-overruns, moral hazard, quality assurance problems and verification problems. Preparations for the PBF program have started during 2017 with a feasibility study, a mapping and rationalization exercise of catchment areas, a two-day seminar with decision makers and, two 14-day PBF courses with in total 70 health professionals.

The second International PBF Course (the 62^nd in total) was held in the Solf Hôtel in Lambaréné from the 10^th to the 22^nd of July 2017. Forty participants took part with eight facilitators and one staff dedicated to the Secretariat. All participants were of Gabonese nationality. 39 participants took the final test of the course and there was 1 distinction of 90% and 3 participants scored 87%.

Hereby the course report (rapport du cours).

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INTRODUCTION AND GENERAL IMPRESSIONS

The 50 course participants with their Certificates in the Presence of the Governor

The 61^st international PBF course was held at Mentong Palace Hotel in Ngaoundéré, from June 19 to July 1, 2017.

Download the detailed course report (rapport du cours)

The main objective of the course was to extend the PBF reform approach in the northern part of Cameroon and notably in the Regions of Adamaoua, North and Far North with in total 7 million inhabitants. These regions have the poorest reproductive health indicators in the country.

The course was marked by the participation of three executives of the Ministry of Civil Registration (BUNEC) from the central level and the Secretary Generals of three Town Halls in Adamaoua Region. The other participants were from the health sector.

The evaluation of the course showed that the course was a success. There were nine distinctions of participants with scores of 90% or more for the final test.

COURSE FINDINGS AND RECOMMENDATIONS Continue reading →

The 26 participants of the June Mombasa course

The 59^th performance-based financing (PBF)  took place in Mombasa, Kenya from Monday May 22 to Friday June 2, 2017.

Hereby the detailed course report.

The next English PBF course will take place also in Mombasa from November 20 to December 2.

The next open French PBF course will take place in Cotonou, Benin from August 21 to September 1, 2017.

In general, the PBF course in Mombasa was a success. All participants passed the final exam and the seven country groups produced impressive action plans (see below). The Sai Rock Hotel at the Mombasa beach is an attractive venue to learn and to think about how to improve health systems in the respective countries represented. The main lessons learned concerning the course were that we should continue to condense the course content with key messages, that we should further discipline the debates, make the PowerPoint presentations shorter and to allow for more group work.

GENERAL OBSERVATIONS / LESSONS LEARNED FROM THE COURSE

The PBF course welcomed participants from seven countries Cameroon, Ethiopia, Lesotho PBF program, Nigeria, South Sudan, Uganda and Zimbabwe. The facilitation team consisted of Godelieve van Heteren, Fanen Verinumbe, Claire Rwiyereka and Robert Soeters. We also welcomed Nicolas de Norman, the director of BlueSquare, who enlightened us with his very spirited vision about the data collection and the integration of PBF within the DHIS2 system. Throughout the two weeks of the course, the country teams engaged in drafting and improving their action plans on how to implement and advance PBF in their countries.

View from the conference Hotel

The daily evaluations resulted in above average scores compared to previous courses. The methods and facilitation and participation and time keeping was above average, while the Hotel services this time was below average.

PBF course content and program materials have expanded considerably since the first course in 2007. Our aim has always been to cover all modules during the 12-days course, but this has become increasingly unrealistic with the new developments and instruments in PBF. The starting level of each participant is also different: some are novice in PBF while other’s have already PBF knowledge and come to the course with specific objectives. Therefore, we try progressively to condense the messages in order to gain time and to tailor the content of the course as much as possible to the needs of each participant. The weight of the exam has considerably increased since 2015. As a result, 11% of the participants during the last 9 courses in 2015-2016 did not pass the threshold of 55% compared to 5% during the previous 8 courses in 2014-2015. Yet, in this Mombasa course all participants manged to pass the exam for which we present our congratulations.

COUNTRY SPECIFIC RECOMMENDATIONS

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The 47 participants with the Douala health authorities

The 58th International PBF Course was held at Makèpe Palace Hotel in Douala from 6 to 17 March, 2017.

Hereby the course report.

Forty-seven participants took part in this course with six facilitators and three staff dedicated to the Secretariat. Thirty-six participants were from Cameroon, three from Central African Republic, two from Burkina Faso, two from Côte d’Ivoire, 1 from Republic Congo, 1 from Democratic Republic of Congo, 1 from Chad and 1 from Switzerland.

In general, the international PBF course in Douala was a success. 88% of the participants said that the course met their expectations and 91% of them appreciated the teaching materials. The reception by the facilitation team was appreciated by 89% of the participants. The action plans of the 14 working groups were generally of high quality compared to previous courses. Yet, the number of modules and exercises to be shared has increased sharply in recent years and, as a result, 42% of participants said the time for the course was too short. The course facilitation will also have to make difficult choices on which modules to share with each individual participant and how to organise this modular approach adapted to the needs of each participant.

The general recommendations of the course

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  Sunset during the social event in Limbe

  Cameroun: Assure the regular payments of PBF invoices by the national PBF Unit. Payment delays are often between 6 and 12 months, which have put at risk the progress of the PBF program and has frustrated all actors, but especially those who depend for a large extent on the PBF subsidies such as the regulatory authorities and the CDV Agencies. At health facility level, this also applies for those activities that are offered free-of-charge to the population such as the support for the vulnerable, home visits, tuberculosis treatment and family planning services. Performance contracts with the national PBF Unit may solve these delays and this should already start in April 2017. New delays in the payment schedule most have consequences for the variable part of their remuneration. The directorates of the MOH should also be put under performance contracts starting from the 1^st of April in at least one directorate.

• Improve the economies of scale of the operations of the district health management teams. Districts should be rationalised into health district units covering around 150,000 people. This implies cutting certain large health districts such as Deïdo in Douala with a population of 800,000 into at least three new health districts. Other districts should be given a principal contract whereby they supervise those districts, which have less than 40,000 population. In the small districts, the medical doctor may concentrate on the hospital activities and leave the regulatory role to another medical doctor operating from another larger health district. All this also to avoid conflicts of interest.
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  Happy moments after obtaining the course certificate

  Set up urgently the CDV Agency for the Central Region with a technically well-equipped team recruited on the basis of competence and competition. In the legal sense, the CDV Agency should be under the umbrella of the Regional Fund for Health Promotion, but it should have a large degree of autonomy to avoid any potential conflicts of interest with the RFHP and notably concerning the distribution of drugs.

• Encourage Regions and CDV Agencies to make the most effective use of their PBF action research budget. Research topics should be identified and discussed during district validation meetings. The research budget should be made available to any actor capable of conducting quality research and could include health facility staff, regulators, members of public health schools. Moreover, it is encouraged that regions seek collaboration with international research institutes to further enhance the quality of their action research.
• Ensure the autonomy of the PBF health facilities by applying derogations for: (a) Authorizing health facilities to open separate commercial bank accounts, which they also control; (b) Applying the market price for the purchase of inputs instead of the higher mercurial prices and; (c) Authorizing health facilities to purchase their inputs from accredited distributors operating in competition.
• Encourage the quick introduction PBF in the Education sector in Cameroon and support the action plan of the Education sector group in Douala.
• Several country teams in the course (Burkina Faso, Chad, CAR (Bekou Fund), DRC, the Republic of Congo and Ivory Coast) propose that the design of their PBF interventions should improve and include more PBF best practices. Details can be found in the follwong paragraphs.

The recommendations from the 14 working groups

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Mombasa sunrise

The next PBF course in French (the 60th) will be held in Cotonou from the 21st of August until the 1st of September, 2017. Hereby, the announcement Annonce and the registration form Fiche for the course. Please contact Aoudi Ibouraima: aaoudi1@yahoo.fr: The cost of the course is Euro 2000 for full board and Euro 1465, without hotel expenses.

The 63rd french spoken PBF course will take place in Bukavu – South Kivu in DRC from the 9th of the 21st of October, 2017. This cours celebrates the fact that 10 years ago the first course took place also in South Kivi. The cost is Euro 1950 per participant. Hereby the announcement and the registration form

The next 12-day English PBF course (Announcement) will take place starting from November 20 to December 1, 2017 Please contact the course coordinator Godelieve van Heteren at sina_health@hotmail.com The cost of this PBF course is Euro 2300 (or $ 2600) for a full 13-day board and lodging with a connection Internet, the availability of course materials, use of advanced technology Turning, collection to drop off at the airport, field trip visit and a social outing on Sundays.