![\"\"](\"http:\/\/www.sina-health.com\/wp-content\/uploads\/59-group-e1497456168766.jpg\")
<\/a>The 26 participants of the June Mombasa course<\/p><\/div><\/p>\n
The 59th performance-based financing (PBF) course took place in Mombasa, Kenya, from Monday, May 22 to Friday, June 2, 2017.<\/p>\n
Hereby, the detailed course report<\/a><\/strong><\/span><\/p>\n 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 on Mombasa beach is an attractive venue for learning and thinking about how to improve health systems in the countries represented.<\/p>\n <\/a><\/a>GENERAL OBSERVATIONS \/ LESSONS LEARNED FROM THE COURSE<\/strong><\/p>\n The PBF course welcomed participants from seven countries: Cameroon, Ethiopia, Lesotho PBF program, Nigeria, South Sudan, Uganda, and Zimbabwe. The facilitation team included Godelieve van Heteren, Fanen Verinumbe, Claire Rwiyereka, and Robert Soeters. We also welcomed Nicolas de Norman, director of BlueSquare, who shared his spirited vision for data collection and integrating PBF into the DHIS2 system. Over the two weeks of the course, the country teams drafted and refined their action plans to implement and advance PBF in their countries.<\/p>\n View from the conference Hotel<\/p><\/div>\n The daily evaluations resulted in above-average scores compared to previous courses. Methods, facilitation, participation, and timekeeping were above average, while hotel services were below average this time.<\/p>\n PBF course content and program materials have expanded considerably since the first course in 2007. Therefore, we progressively condense the messages to save time and tailor the course content as closely as possible to each participant’s needs. The exam’s weight has increased considerably since 2015. As a result, 11% of participants in the last 9 courses in 2015-2016 did not pass the 55% threshold, compared with 5% in the previous 8 courses in 2014-2015. Yet, in this Mombasa course, all participants passed the exam, and we congratulate them.<\/p>\n <\/p>\n Walk in the game park<\/p><\/div>\n Cameroon launched PBF first in the East Region in 2006 with the Catholic Church and Cordaid, followed by a World Bank-financed pilot program in 2011 in four Regions. In 2016, the government declared PBF its national policy and its approach to achieving Universal Health Coverage objectives. In 2017, the government is scaling up PBF from 25% of the country to cover 50% of the population and aims, in particular, to roll out PBF in the three Northern Regions, which were recently affected by instability due to Boko Haram. The three participants from Cameroon came from the South West Region.<\/p>\n Recommendations Cameroon<\/strong><\/p>\n Buffalos<\/p><\/div>\n Ethiopia has started a small Cordaid-initiated pilot in four districts in Oromia State with 126,000 inhabitants. The representative from Ethiopia presented several implementation problems with the Cordaid pilot program, including a strategy change required by the prolonged dry season. Another problem was the slow uptake of PBF subsidies by health facilities. This points to a more systemic problem with the PBF program’s design.<\/p>\n The Cordaid representative in Mombasa recommends supporting PBF health facilities through more robust verification and coaching. Another recommendation is to better inform relevant authorities about PBF to scale up the pilot to other areas of the region and the country.<\/p>\n The development and health indicators are poor, with notably the very high maternal mortality rate of 1,024 per 100,000 live births. The HIV prevalence rate among adults is one of the highest in the world, at 23%. Despite considerable investments in the health sector, they have not yielded the desired results. In response, the government began testing PBF in 2014 to reduce inefficiencies and achieve better results, first in two districts and later in six districts covering around 50% of the population. The feasibility score conducted by the Lesotho participants in Mombasa was 50%. This implies that design improvements are still required.<\/p>\n Restaurant Shimba Hills<\/p><\/div>\n Recommendations Lesotho<\/strong><\/p>\n Waterfall of eternal life<\/p><\/div>\n The health system has three levels, primary, secondary, and tertiary, with no clear role definitions for each tier. Nigeria has sub-optimal health services and the maternal mortality rate is high with 576 per 100 000 live births with a very unequal distribution over the States and unfavourable for the States in the North-East such as Borno, Yobe and Bauchi. Donor coordination and monitoring systems are weak. Many states view health as a social good, with inefficient free medical services.<\/p>\n Based on results since 2011 in the three pilot States, the Nigerian team felt that PBF could significantly improve health outcomes by shifting away from input financing and focusing on quality and outputs.<\/p>\n General recommendations for Nigeria<\/strong><\/p>\n Specific recommendations for Nigeria<\/strong><\/p>\n Best participant of the day<\/p><\/div>\n After two relatively calm years of peace following its 2011 independence, the country has descended into internal and external strife since 2013. As a result, the population has been displaced, and access to food and social services remains limited. Cordaid currently works in several States in South Sudan, but so far has mostly used traditional, input-oriented health programs. Yet Cordaid also recognizes the importance of performance-based systems and decided to send a four-member team to Mombasa to assess what it can do. South Sudan has poor health impact indicators such as the very high maternal mortality rate of 789 per 100,000 live births. The health system is extremely donor-driven and implemented by International NGOs, with at least 90% of public health expenses financed by external sources. A vibrant local, mostly informal, private sector exists, but government and development partners ignore it. South Sudan’s distribution system is input-oriented, supply-driven (\u201cpush\u201d), and does not allow competition. Stimulating and regulating fair competition in South Sudan’s private sector is not yet a government priority. As a result, stock-outs are frequent, and there are doubts about the quality of drugs brought into the country. The \u2018zero cash policy \u2019 allows only in-kind inputs to health facilities. This is a de facto pure centralized planning approach with an inefficient and ineffective input policy;<\/p>\n Recommendations South Sudan<\/strong><\/p>\n The Uganda health system faces major challenges, and the government is trying to design an effective RBF\/PBF to address them. For about 15 years, smaller RBF\/PBF pilots have been run, providing useful lessons. A new framework has been developed to implement RBF in two-thirds of the country. Yet the Mombasa team scored the current design’s feasibility at only 42% and identified several areas for improvement.<\/p>\n Recommendations Uganda<\/strong><\/p>\n Given the discrepancies between the PBF best practices and the currently proposed RBF National Framework design, the Uganda team proposes:<\/p>\n<\/a><\/a>COUNTRY SPECIFIC RECOMMENDATIONS<\/h2>\n
<\/a>CAMEROON<\/h3>\n
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<\/a>ETHIOPIA<\/h3>\n
<\/a><\/a>LESOTHO<\/h3>\n
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<\/a>NIGERIA<\/h3>\n
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<\/a>SOUTH SUDAN<\/h3>\n
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<\/a>UGANDA<\/h3>\n