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Ministry of Health & Social Welfare Experiences in PBF Program in Liberia. Community of Practice Conference March 18-19, 2011 Saly (Senegal) By Benedict C. Harris & Dominic Togba. Outline. Country context PBF Policy Development Design & Implementation

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ministry of health social welfare experiences in pbf program in liberia

Ministry of Health & Social Welfare Experiences in PBF Program in Liberia

Community of Practice ConferenceMarch 18-19, 2011Saly (Senegal)

By Benedict C. Harris & Dominic Togba

  • Country context
  • PBF Policy Development
  • Design & Implementation
  • Description of Experiences (actors, intervention sites)
  • Areas of concern
  • Lessons Learnt & Next Steps
country context
Country Context
  • High Maternal mortality: 994/100,000
  • High Child mortality: 110/1000 (LDHS)
  • High poverty level (64% below poverty line)
  • Political stability and economic recovery and growth:
    • GDP: 2008/09 remains constant at around 10%
    • Liberia is 7th fastest growing economy in 2009 out of 44 countries
mohsw vision mission
MOHSW Vision & Mission
  • Vision:
    • 2011: is moving away from the post-conflict mentality to a vision of “Healthy population with social protection for all”
  • Mission:
    • “reform and manage the sector to effectively and efficiently deliver comprehensive, quality health and social welfare services that are equitable, accessible and sustainable for all people in Liberia”
pbf policy
PBF Policy
  • Increase equitable access health services
  • Improve the qualityof service provision
  • Strengthen national and county supportsystems to restore government management of government health facilities
pbf implementation approaches
PBF Implementation Approaches:

Piloted a mixture of approaches :

  • Contracting in- one level of government contracts with another
  • Contracting out- a partner is contracted with complete authority over all resources (human, material and financial) to provide health services
pbf design implementation
PBF Design & Implementation
  • Contracting In:
    • Bomi County Health Team
    • Provision of BPHS in 19 health facilities
    • Bomi subcontracted with African Humanitarian Aid (AHA) to support provision of BPHS in 6 facilities
    • Amount: USD 2.1 Million (MoHSW Pool Fund*)
    • Period: Nov 2009-June 2011
  • Contracting Out:
    • 5 NGOs (Merlin, AHA, International Rescue Committee, Save-the Children-UK and Pentecostal Mission Unlimited (PMU))
    • Provision of BPHS in 100 facilities
    • 5 Counties: Maryland, Grand Gedeh, Nimba, Montserrado and Lofa
    • Amount: USD 18.5 Million (MoHSW Pool Fund)
    • Period: November 2009-June 2011

*MOHSW Pooled Fund established in April 2010 (with an initial 2-year timeframe) backed with DFID, Irish Aid and EU financial support

pbf key accomplishments
PBF Key Accomplishments
  • PBF Structure:
    • Establishment of PBF Steering Committee
    • Set up a PBF sub-unit at MoHSW
    • Development of policy document and PBF contracts :
    • National PBF indicators selected
    • PBF targets selected (in progress)
    • PBF payment plan and budget developed
    • PBF M&E and data verification plan developed
  • Capacity building :
    • Study tour in Rwanda
    • Training of trainers (national and Bomi CHT)

NB: Strong partnership with RBHS/MSH

  • Implementation constraints:
      • Lack of operation/implementation manual and tools providing guidelines for implementation
      • M&E and Data verification mechanism not yet fully operational
      • Delay in payment of the performance bonus to providers (leading to lack of motivation)
      • Few people trained in PBF implementation
  • Financial sustainability:
      • Pool fund : funds available up to June 2011
lessons learned
Lessons Learned
  • Retention of HRH in Bomi
  • Minimized HRH staff turnout
  • Need to have a complete unit responsible for PBF and fully staffed /capacitated
  • Avoid grey areas: Be able to clearly define roles and responsibilities of stakeholders (providers, contracting agency, etc)
  • Make transactions more efficient; providers performance bonus needs to be paid more frequently and timely
next steps dates
Next Steps & Dates
  • Key activities* (2011):
    • Assessment of the PBF institutional and implementation arrangements
    • Development of the PBF operational manual
    • development of a detailed road map and costing/budget for long term sustainability
    • Conduct training of key implementers:
      • TOT (PBF Technical Committee, PBF Unit, NGOs implementing PBF)
      • Training of CHTs: PBF Task Force, Secretariat and validation Teams
      • Training of Health staff (community health dev, committee; staff at health centers/clinics)

*: with technical support from RBHS and World Bank

next steps dates1
Next Steps & Dates
  • PBF scale-up plan:
    • Phase 1 (2011): Improve and consolidate existing PBF programs with NGOs and Bomi CHT
    • Phase 2 (2012-13): Extend PBF program to CHTs in 5 counties (where NGOs already operate including RBHS); Introduce PBF program at the hospital level
    • Phase 3 (2014-15): Extend PBF to all counties and shift NGOs roles to support CHT and health facilities; introduce Community PBF program