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Presented by Michael m. Amara (MoHS – Principal health economist)

PBF CONFERENCE 14 TH -17 TH FEBRUARY 2011 BUJUMBURA, BURUNDI. DESIGNING OF Sierra Leone simple performance based financing Scheme (PBF). Presented by Michael m. Amara (MoHS – Principal health economist). Outline of the presentation. Sierra Leone Simple PBF Scheme

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Presented by Michael m. Amara (MoHS – Principal health economist)

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  1. PBF CONFERENCE 14TH -17TH FEBRUARY 2011 BUJUMBURA, BURUNDI DESIGNING OF Sierra Leone simple performance based financing Scheme (PBF) Presented by Michael m. Amara (MoHS – Principal health economist)

  2. Outline of the presentation • Sierra Leone Simple PBF Scheme • Rationale for PBF in Sierra Leone • Objectives of Simple PBF Scheme • Outline of Simple PBF Scheme • Simple PBF Interventions • Simple PBF Prices 2011 • Implementation Arrangements • Institutional Structure • Key Roles and Responsibilities. • Reporting and verification procedures • Implementation Process • Achievements • What Next? • Conclusion

  3. Rationale for PBF in Sierra Leone • High mortality and morbidity especially among young children and mothers • Financial barriers preventing mothers and children from accessing health care are being tackled through the Free Health Care policy • We also need to improve the availability of good-quality health services for them to access • PBF can help us achieve this!

  4. Objectives of Simple PBF Scheme General objective: • To change the behaviour of health providers at facility level for them to deliver more quality services and to increase their productivity in the health sector. Specific objectives: • To increase service utilization at primary health care facility. • To improve quality of service delivery at primary health care facility

  5. Outline of Simple PBF Scheme • Start in April 2011, funding available till October 2013 • PHUs receive PBF funds every quarter based on delivery of six key Reproductive and Child Health interventions • PBF funds are divided between incentives for staff and investment or operational costs for the facility • DHMT and Local Council supervise and verify service delivery and use of the PBF funds • Ministry of Health and Sanitation has oversight over entire scheme

  6. Simple PBF Interventions The Simple PBF Scheme is based on six key RCH interventions: • Family planning (BPEHS 7.2) • Antenatal care of pregnant women (BPEHS 7.1.1.) • Safe childbirth deliveries (BPEHS 7.1.2) • Postnatal care of mothers and babies(BPEHS 7.1.4) • Routine immunisations for children under one (BPEHS 7.6) • Outpatient consultations for children under five (BPEHS 7.7)

  7. Simple PBF Interventions (cont) Why were these six interventions chosen? • Part of the Basic Package of Essential Health Services • Complements Free Health Care policy: all six interventions are aimed at the FHC target groups • The most effective interventions for reducing child mortality help Sierra Leone achieve MGD 4 • The most effective interventions for reducing maternal mortality help Sierra Leone achieve MGD 5

  8. FUND HOLDER SERVICE PROVIDER REGULATOR INDEPENDENT VALIDATOR NATIONAL LEVEL Independent Validation Agency Contract MoFED: Local Govt. Finance Department Ministry of Health and Sanitation PBF Supervision/ Verification Agreement DISTRICT LEVEL Local Council District Health Management Team Independent Validation Agency Tripartite PBF Agreement COMMUNITY LEVEL Peripheral Health Unit or Clinic Health Management Committee Institutional Structure and Agreements

  9. Key Roles and Responsibilities • The Ministry of Health and Sanitation is the national regulator of Simple PBF Scheme: • Design of the scheme in collaboration with stakeholders: setting the rules, indicators, prices. • Monitoring and evaluation of implementation • The Ministry of Finance and Economic Development (LGFD) is the national fundholder for the Simple PBF Scheme • Disburses PBF funds to local councils on receipt of verified PBF reports • The Local Council (LC) is the local fundholder and purchaser of health services for the Simple PBF Scheme • Contracts PHUs to provide health services, jointly with the DHMT • Disburses PBF funds to PHUs • Supervision of PHUs jointly with DHMT (focus on financial management and data verification)

  10. Key Roles and Responsibilities (cont) • The District Health Management Team (DHMT) is the local regulator of the Simple PBF Scheme • Leads on implementation and training at district level • Supervision of PHUs jointly with LC (focus on clinical supervision and data verification) • The Peripheral Health Unit (PHU) is the service provider for the Simple PBF Scheme • Provides primary healthcare services to the population, including the six key PBF interventions • Receives and spends PBF funds • Reports regularly to DHMT and Local council on service delivery and use of PBF funds • A contracted agency (NGO or CSO) working in conjunction with local health management committees will provide independent validation of the PBF performance reports

  11. Implementation Process: Achievements • Technical Team formed to design the Simple PBF Scheme and draft the Operational Manual • Consultative meetings held with World Bank staff and • Technical support funded by World Bank • First draft of the operational manual circulated for comments and inputs • Consultative meeting with all stakeholders: MoHS directors and managers, DMOs, district M&E officers, Local Council chairs, health sector development and implementing partners • Revised draft of the operational manual produced and circulated for further comments and inputs • Training Manual for Training of Trainers produced • Training of Trainers (TOT) conducted in Bo, 11th – 21st January 2010 (DHMT and LC M&Es, District Health Sisters)

  12. Implementation Process: What Next? • Finalise the Operational Manual for approval by MoHS and submission to the World Bank • Districts to organise Cascade training for PHU In-Charges and other key personnel (February/March 2011) • Roll-out of revised data reporting tools • PBF implementation starts on 1st April 2011

  13. PBF Reporting, Supervision and Verification Process Peripheral Health Unit or Clinic PHU submits DHIS forms to DHMT by 5th of every month PHU DHIS forms Joint Supervision and Verification checklist completed and data entered by quarter end Internal Verification Team Supervision and Verification Checklist District Health Management Team PBF Report DHMT completes data entry of all forms and submits DHIS data to MoHS by 15th of every month DHMT submits PBF report to LC by 18th of month after quarter end, cc MoHS Local Council DHIS Data ____ Certified PBF Report LC certifies PBF Report and submits to MoHS by 30th of month after quarter end Ministry of Health and Sanitation Approved and Compiled PBF Report MoHS approves reports from LCs, compiles and forwards to LGFD by 5th of second month after quarter end MoFED: Local Govt. Finance Department

  14. PBF Payment Disbursement Process Approved and Compiled PBF Report LGFD receives PBF Report and by 5th and disburses PBF payments to LCs by 10th of second month after quarter end Ministry of Health and Sanitation MoFED: Local Govt. Finance Department Report on disburse-ment to LCs LGFD copies disbursement information to MoHS PBF Payment for PHUs and Internal Verification Team ____ LC copies disburse-ment information to DHMT Local Council District Health Management Team LC disburses PBF payments to PHU and IVT accounts by 15th of second month after quarter end Report on disburse-ment to PHUs PBF Payment for PHU ____ PBF Payment for IVT ____ Peripheral Health Unit or Clinic Internal Verification Team

  15. PBF Financial Record Keeping and Reporting Process Peripheral Health Unit or Clinic Internal Verification Team IVT submits PBF financial report to DHMT by 5th of month after quarter end PHU submits PBF financial report to DHMT by 5th of month after quarter end PHU PBF Financial Report IVT PBF Financial Report District Health Management Team Local Council Aggregated PBF Financial Report DHMT aggregates PHU financial reports and submits to LC by 15th of month after quarter end, copying MoHS LC approves aggregated financial report and submits to LGFD by end of month after quarter end Aggregated PBF Financial Report Approved PBF Financial Report LGFD approves financial reports from LCs, compiles and forwards to MoHS by 10th of second month after quarter end MoFED: Local Govt. Finance Department Ministry of Health and Sanitation Compiled PBF Financial Reports LGFD submits consolidated Interim (un-audited) Financial Report to WB – IDA by 45 days after quarter end Consolidated Interim Financial Report

  16. Conclusion The PBF system will not replace the existing structure of healthcare services, but will complement them and increase the health workers’ productivity.

  17. Thank you

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