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CHAZ PBF Experience. PBF Conference for the Multi-country network held in Burundi 14 th – 17 th February 2011 Churches Health Association of Zambia Box 34511, Ben Bella Road, Lusaka, Zambia Phone 260 1 229702/237328, Fax: 260 1 223297, Cell: 0979568292/0977790499 Email:

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CHAZ PBF Experience

PBF Conference for the Multi-country network held in Burundi

14th – 17th February 2011

Churches Health Association of Zambia

Box 34511, Ben Bella Road, Lusaka, Zambia

Phone 260 1 229702/237328, Fax: 260 1 223297, Cell: 0979568292/0977790499




CHAZ Background Information

  • Formation & Membership
  • Formed in 1970 ( Catholic and Protestant Medical Committees)
  • Interdenominational (Catholic and Protestant) umbrella organisation for 146 CHIS in 9 Provinces and 56 Districts (out of 72):
    • 36 Hospitals & 81 RHCs & 9 Training Schools
    • 29 CBOs: 20 Community Based Programmes & 9 Catholic Dioceses
  • Health Services Coverage
  • CHAZ is the second largest provider of health services in Zambia.
  • MoU with the MoH: 75% Grant, 90% Staff , 90% Essential Drugs
  • Principal Recipient Status
  • PR for the Global Fund Mechanism in Zambia for all the 3 disease components: HIV/AIDS (including ART), Malaria & TB.
  • Others
  • Recipient of the Joint Financial Arrangement (JFA)
  • One of the major PBF implementers in the country

“He sent them to preach the Kingdom of God and heal the sick” Luke 9:2

project objectives
Project objectives

Overall objective

The overall purpose of the PBF project is to safeguard health sector performance and contribute to the achievement of a better health status of the Zambian population.

Specific Objectives

  • To build capacity among church health and government institutions and the CHAZ secretariat for the gradual introduction of performance based financing
  • To document experiences, conduct action research and share lessons learnt on PBF and its various dimensions
  • To promote effective community participation in relation to PBF
  • To actively take part in the international network of exchange (community of practice) on PBF that is unfolding.

History of P4Pin Zambia

In 3 Dioceses (Mansa, Mpika and Chipata) 6 hospitals, 7 health centres

Mansa Diocese: (started 1-1-2007),St. Paul’s Hospital, Lubwe Hospital, Kasaba Hospital, Health desk

Chipata Diocese

Minga Hospital (started 1-1-2007), Lumezi Hospital

(started 1-1-2008), Kanyanga HC (started 1-1-2008), Muzeyi HC (started 1-1-2008), Health Desk (started 1-1-2008)

Mpika Diocese:

Our Ladies Hospital (Chilonga) (started 1-1-2007), Chalabesa HC,

(started 1-7-2008), Mulanga HC (started 1-7-2008)Ilondola HC (started 1-7-2008), Mulilansolo HC (started 1-1-2009),Health Desk (started 1-7-2008)

“He sent them to preach the Kingdom of God and heal the sick” Luke 9:2


P4P Evaluation

  • Evaluation was done in the 3 dioceses
  • Revealed both positive and negative outcomes
  • Recommended the involvement of a local stakeholder (CHAZ) in project management
  • Extensive involvement of the stakeholders in health
  • Identified a need for a pilot on proper PBF interventions
  • Use of a more contextualized approach in the design process

“He sent them to preach the Kingdom of God and heal the sick” Luke 9:2

the chaz pbf pilot project
The CHAZ PBF Pilot Project
  • 2 districts selected for PBF piloting
  • Selection based on a set criteria
  • EU Funded PBF is a multi country project,
  • Pilot implemented in 3 years from Jan 2010 – Dec 2012
implementation strategies
Implementation strategies

Seven core strategies will be employed to implement the project:

  • Actual (co-)financing of (health) services based on past performance, through the conclusion of service agreements for church health institutions
  • Capacity building
  • Exchange visits and peer review
  • Action research
  • Site visits for monitoring purposes
  • Consultation at national, district and community level
  • Documentation and dissemination
chaz involvement
  • Following the recommendation for CHAZ involvement in P4P
  • In July 2009 CHAZ studied the P4P situation and sensitized the stakeholders on PBF development
  • Advocacy for PBF to all stakeholders
  • Developed institutional framework (WB, UNZA, MoH, DHMT)
  • Shared PBF strategies with the TWG-MoH
  • TWG accepted the CHAZ PBF strategy
  • Selected districts shared with MoH
pilot district selection criteria
Pilot District Selection Criteria
  • Rural district
  • Church presence (in view of Govt/FBO collaboration), in particular:

the number of hospitals and h/centres and share of churches’ catchment population as a % of total district population

  • P4P history (with Cordaid)
  • Not an RBF district (intervention or control district) in the WB supported project
  • Workload in terms of staff/contact ratio: preferably average (neither high nor low)
  • Disease burden: child malnutrition (% underweight), pneumonia, % institutional deliveries
  • Catchment population served by church health institutions: ideally not more than 100,000.
chaz pbf implementation structure
CHAZ /PBF Implementation Structure

The project emphasizes on split of responsibility

  • Fundholder Agency - CHAZ
  • Regulator – quality standards - DHMT
  • Local Purchasing Agency – responsible for contracting - ZSIC
  • Local Verifier Organisation– client satisfaction surveys
  • Health facilities – DOPE and DAPP
  • Community organizations/committees – NHC, HCC, HAC
verification procedure
Verification procedure


  • Done by local quality experts with performance contracts
  • Follow agreed upon quality standards
  • Give a score expressed in percentage
  • Quality will determine the absolute score (rewards =Quality*quantity*performance index)

Quantity/data verification

  • Conducted by the LPA - ZSIC
  • Produces provisional invoices based on data results

Client Tracer surveys

  • Conducted by a locally based NGO – contracted
  • Results inform the next quarter business plans for the facility
  • In future, survey results will determine


  • Are consolidated by the PBF district steering committee
where are we
Where are we?
  • Project design finalized
  • Actual implementation commenced in July, 2010
  • Baseline survey conducted
  • Desk review on existing levels of performance contracting in CHAZ
  • Performance verification for quarter three (2010) conducted
  • Project implementation manual
  • Capacity building activities for policy makers and implementers
  • Collaboration with other stakeholders - Trainers, LPA, Local verifier organizations
  • Shared experiences with stakeholders in the country

Sustainability plan for the CHAZ PBF scheme:

  • Involvement of other critical stakeholders (Local purchaser, Community organisations, MoH, UNZA)
  • Member of the TWG-HCF and the PBF national steering committee
  • Transparency about PBF-funding / Inequity
  • Intergrated planning and reporting for PBF
  • Community involvement – possible gradual intriduction of pre-financing schemes
  • Gradual intergration of PBF into the routine CHAZ program management

“He sent them to preach the Kingdom of God and heal the sick” Luke 9:2