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Performance Based Financing at Hospital - Liberia Health Systems Strengthening Project (HSSP)

Performance Based Financing at Hospital - Liberia Health Systems Strengthening Project (HSSP). July 8, 2013 Harry Neufville Shun Mabuchi . Hospitals have not been paid sufficient attention despite their importance, leading to low quality of care. Health Financing Trend.

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Performance Based Financing at Hospital - Liberia Health Systems Strengthening Project (HSSP)

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  1. Performance Based Financing at Hospital- Liberia Health Systems Strengthening Project (HSSP) July 8, 2013 Harry Neufville Shun Mabuchi

  2. Hospitals have not been paid sufficient attention despite their importance, leading to low quality of care Health Financing Trend Quality of care at Hospitals 19% of total health budget allocated to tertiary care in 2010/11 Most external funds (85% of health expenditure in 2009/10) directed at primary care No major donor support to secondary-level hospitals High infection rates and post-surgery complications No systematic use of clinical guidelines Accreditation scores on quality are worse than primary facilities

  3. The hospital PBF aims to improve the quality of care at the hospital level Project Development Objective of the HSSP Improve the quality of maternal health, child health, and infectious disease services in selected secondary-level health facilities* 1. Hospital PBF 2. Competency building through GMRP Incentives for improved quality of care (structural and process) Coaching and verification support to hospitals Rotation of faculties and residents to hospitals In-service training to health workers at the hospitals * PBF for Redemption (Montserrado), Phebe (Bong), Tellewoyan (Lofa), JFD (Nimba), and JJ Dosen (Maryland)

  4. Hospitals will receive financial incentives and management and clinical support to improve the quality of care Accountability and Motivation Competency Building PBF on the improve-ment of: • Hospital management practices • Availability of essential drugs and equipment • Adherence to clinical guidelines and protocols • Hands-on coaching by LMDC on quality improvement approaches and PBF management • In-service training by faculties and residents on appropriate protocols and process of care Quality Improve-ment of hospitals

  5. Hospital will also receive incentives for the uptake of under-utilized and under-provided hospital services 4

  6. Use of performance incentives by hospitals based on business plan Investment: 50% of incentives for facilities, equipment, drugs, operational cost Better facilities Hospitals can use the performance incentives for improving hospital services Improved quality of care at hospitals More PBF incentives Motivation: 50% of incentives for individual health worker incentives Motivated health workers Virtuous cycle of continuous performance improvement with PBF 5

  7. 2 Bi-annual external verification by medical college (e.g., from West African College) 3 The quality of care and the utilization will be rigorously verified in multiple ways Community verification and customer satisfaction by CBOs 1 Quarterly verification by LMDC Quality assessment using rigorous quality checklist Comparison of invoice and register patient by patient Direct visit to registered patient to check the actual utilization of services Simple questionnaire on customer satisfaction 6

  8. Motivate toward more trainings Hospital PBF Competency Building The HSSP also seeks for the synergetic linkage of PBF and competency building Quantity incentive finances in-service training to health workers Quality incentive finances the adherence to clinical protocols In-service training train nurses, midwives and PAs on proper clinical protocols on hospital services Synergetic linkage of components Better competency to improve process of care 7

  9. Health Sector Coordination Committee Dept. of Admin HSSP Coordination Office Dept. of Health Services (PBF Unit) Dept. of Planning LMDC CHSWT (Local Regulator) Post-Graduate Medical Council Target Hospitals MOA/Contract CBOs Oversight/Support Patients Service Delivery Verification and TA Project Technical Committee Focal Persons’ Forum HSSP Implementation Arrangement 8

  10. Pre-pilot Scale-up Counties Population Facilities 2 1 • June-Dec, 2013 • 2014-18 The project will start from pre-pilot to test and adjust approaches, then scale up to all hospitals • 1 • 5 • Redemption • Redemption PhebeTellewoyan, JFD, • JJ Dosen • 0.34 million • ~1 million 9

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