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Community PBF in R wanda

Community PBF in R wanda. CHD 2013. STRUCTURE. Introduction. In 2005, MOH has reinforced 3 major stratagies to improve the health quality services: CBHI(Community Based Health Insurance) Performance based financing Quality assurance

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Community PBF in R wanda

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  1. Community PBF in Rwanda CHD 2013

  2. STRUCTURE

  3. Introduction • In 2005, MOH has reinforced 3 major stratagies to improve the health quality services: • CBHI(Community Based Health Insurance) • Performance based financing • Quality assurance • The Community PBF started in January 2006, in all districts of Rwanda, with funding throught the local administration

  4. Selected indicators 2006-2008 • Number of members of CBHI(Community Based Health Insurance) , • Mobilisation of assisted delivery, • Mobilisation in using LLIN(Long Lasting Insecticide Nets) • Treatment of dehydration of children under 5 years, • Hygiene • Report of Community Activities.

  5. Challenges of this model of Community PBF 2006-2008 • Use of funds for other priorities of the districts • Delay in reporting indicators • Delay in transfering funds by the districts • Lack of motivation to supervise the community activities • Lack of tools in data collaction • No reports from the districts to MOH • Lack of mechanisms for data verification

  6. New model CPBF : 2009 • Designed in 2009 to change the challenges of the old model: • Trought the TWG of CPBF (MOH and parteners WB, USAID/MSH, HDP etc…) • In december 2007: first draft of Community PBF • The new model proposed in different Health Centers for review and considerations (MOH department of policies ; Senior Management; Health Financing Unit ; Technical Working Group of Community PBF etc)

  7. Making decision • Results from the evaluation of selected HCs on the impact of CPBF show that MOH has reached : • Increasing of utilization of health services – Assisted delivery, Preventive of Health care of children under 5 years • Increasing health quality – Post natal care and immunization • Results also show that expanding of PBF at the Community level can reduce the difficult to realize the MCH indicators: • Nutritional status • Timely prenatal care utilization • Institutional delivery • Timely postnatal care utilization • Modern contraceptive use

  8. INDICATORS REMUNERATED: • Nutrition Monitoring: % of children monitored for nutritional status • ANC : Women accompanied/referred to Health Center for prenatal care within first 4 months of pregnancy • Deliveries: Women accompanied/referred to HC for assisted deliveries • Family Planning: new users referred by CHWs for modern family planning methods • Family Planning: % of regular users using long term methods (IUD, Norplant, Surgical/NSV contraception) • Number of TB suspects referred to the health center by the CHW’s • Number of TB patients receiving DOTS at home • Number of couples referred to a health center for PMTCT • Number of households referred to a health center for VCT • CHW’s Reports

  9. Signing Contracts of Community PBF: • Improves performance • Payments made when proof of the agreed level of performance • The Sector Steering Committee signed the community contracts • Data entered at district level web-based database

  10. www.pbfrwanda.org.rw/siscom

  11. Mécanisme contractuel entre acteurs • Financement forfaitaire d’un seul résultat trimestriel: Rapport des ASC avec suivi spécifique de 5indicateurs (Modèle national)

  12. Community Health Information System Data Flow Chart

  13. CHWs Motivation • Trust and respect from community members, leaders etc… • Support from Supervisors and implementation partners help improve work; • Regular trainings, meetingssupervision • In-country study tours to learn from peers in other districts • Distance learning • Community performance-based financing (PBF); • Membership in cooperatives for income generation

  14. CHWs’ Cooperatives • - Community Health Workers’ (CHWs) cooperatives were initiated in late 2007 • - The model was introduced through a transformation process from CHWs non profit making associations • - Previously, they had associations that were no more than a forum to receive and share funds from MOH, and after each member would do as they wished with that money • - Up to-date, 449 cooperatives exist country wide • - However, more are being formed as there are new health centers emerging • 100% are operational with approximately 42% CHWs cooperatives legally registered at national level • - Objective is to have all cooperatives with a legal certificate by end of first quarter 2012 because of the importance of registration • - This shall be possible through close collaboration between MOH, district authorities and RCA

  15. Achievements for CPBF Program • Implementation of Com PBF in all districts • CHW’S are remunerated by quarter(449 CHWs cooperatives) • Sector Steering Committee are trained on reporting and on all tools used in reporting and counter verification data • New revised CPBF Contracts in KINYARWANDA are signed between the SSC and HC;SSC and CHW’s Cooperatives • CHW’s cooperatives data reports are validated by Sector Steering Committees and submitted to the Community PBF • Health centers and SSC are the principal evaluators in data reported by the CHW’S and data entered by HC • District Steering Committee and DH are the second evaluators before sending the reports to the Central level • Central level make analysis on the data reported by the CHW’s before the payment

  16. Achievements for CPBF Program • Monthly CPBF Subcommittee meeting • Monthly Extend Team PBF meeting • Community PBF Audit system is done and the report available • Community PBF Counter verification data, audit is done and the report is available • Results dissemination for Community PBF counter verification data presented in coordination meeting with the districts

  17. Program Challenges • Training: CHWs need training in essential service delivery, data reporting, and income generation; • Robust verification mechanisms to ensure that minimum package of community health services has been delivered; • The logistics to deliver the minimum package of community health services; • Data verification mechanisms on reported indicators; • Communication issues: cell phones for reporting and sharing information regarding the community-based activities; • Issues related to the design and management of community health workers’ income generating activities (cooperatives)

  18. PRIORITIES • Reinforce and increase the data reports provided by the CHW’s • Reinforce counter verification data at all levels • Reinforce the data analysis reports from CHW’s by the Sector Steering Committee and Districts Steering Committee • Reinforce keeping all reports from villages to cells and to be analysed by the Sector Steering Committees • Regular supervision by Central Level in data collection by Sector Steering Committee and District Steering Committee

  19. HE Paul KAGAME with all CHWs

  20. Merci

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