What is PBF?

PBF CONFERENCE

14TH -17TH FEBRUARY 2011

BUJUMBURA, BURUNDI

DESIGNING OF Sierra Leone simpleperformance based financingScheme (PBF)

Presented

Michael m. Amara

(MoHS – Principal health economist)

Outline of the presentation

1.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

2.Implementation Arrangements

•Institutional Structure

•Key Roles and Responsibilities.

•Reporting and verification procedures

3.Implementation Process

•Achievements

•What Next?

4.Conclusion

Rationale for PBF in Sierra Leone

High mortality and morbidity especially amongyoung children and mothers

Financial barriers preventing mothers andchildren from accessing health care are beingtackled 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!

Objectives of Simple PBF Scheme

General objective:

To change the behaviour of health providers atfacility level for them to deliver more quality servicesand to increase their productivity in the healthsector.

Specific objectives:

To increase service utilization at primary health carefacility.

To improve quality of service delivery at primaryhealth care facility

Outline of Simple PBF Scheme

Start in April 2011, funding available till October 2013

PHUs receive PBF funds every quarter based ondelivery of six key Reproductive and Child Healthinterventions

PBF funds are divided between incentives for staff andinvestment or operational costs for the facility

DHMT and Local Council supervise and verify servicedelivery and use of the PBF funds

Ministry of Health and Sanitation has oversight overentire scheme

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 (BPEHS7.7)

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 sixinterventions are aimed at the FHC target groups

•The most effective interventions for reducing childmortality  help Sierra Leone achieve MGD 4

•The most effective interventions for reducing maternalmortality  help Sierra Leone achieve MGD 5

SIMPLE PBF PRICES for 2011

PBF Indicator

PBF Price (US$)

N1 = Number of new acceptors of modern family planning methods.

2.4

N2 = Number of pregnant women completing series of four antenatalconsultations.

1.4

N3 = Number of pregnant women in labour attended by a healthprofessional, at the facility.

2.4

N4 = Number of women completing series of three postnatalconsultations

1.4

N5 = Number of children aged less than 12 months completingnational EPI immunization course.

1.4

N6 = Number of outpatient visits of children under five

0.1

Institutional Structure and Agreements

REGULATOR

FUND HOLDER

NATIONALLEVEL

SERVICE PROVIDER

INDEPENDENT VALIDATOR

COMMUNITYLEVEL

DISTRICTLEVEL

IndependentValidation AgencyContract

Tripartite PBFAgreement

District HealthManagementTeam

PBF Supervision/VerificationAgreement

Peripheral HealthUnit or Clinic

MoFED: LocalGovt. FinanceDepartment

HealthManagementCommittee

IndependentValidation Agency

Local Council

Ministry of Healthand Sanitation

The Ministry of Health and Sanitation is the national regulator ofSimple 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 thenational 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 healthservices 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 managementand data verification)

Key Roles and Responsibilities

The District Health Management Team (DHMT) is the local regulator ofthe Simple PBF Scheme

Leads on implementation and training at district level

Supervision of PHUs jointly with LC (focus on clinical supervision and dataverification)

The Peripheral Health Unit (PHU) is the service provider for the SimplePBF Scheme

Provides primary healthcare services to the population, including the sixkey PBF interventions

Receives and spends PBF funds

Reports regularly to DHMT and Local council on service delivery and use ofPBF funds

A contracted agency (NGO or CSO) working in conjunction with localhealth management committees will provide independent validationof the PBF performance reports

Key Roles and Responsibilities (cont)

Implementation Process: Achievements

Technical Team formed to design the Simple PBF Scheme and draft theOperational 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 developmentand implementing partners

Revised draft of the operational manual produced and circulated forfurther comments and inputs

Training Manual for Training of Trainers produced

Training of Trainers (TOT) conducted in Bo, 11th – 21st January 2010 (DHMTand LC M&Es, District Health Sisters)

Implementation Process: What Next?

Finalise the Operational Manual for approvalby MoHS and submission to the World Bank

Districts to organise Cascade training for PHUIn-Charges and other key personnel(February/March 2011)

Roll-out of revised data reporting tools

PBF implementation starts on 1st April 2011

PBF Reporting, Supervision and Verification Process

MoFED: Local Govt.Finance Department

District HealthManagement Team

Ministry of Health andSanitation

Peripheral Health Unit orClinic

PHU submits DHISforms to DHMT by 5thof every month

Joint Supervision and Verificationchecklist completed and dataentered by quarter end

DHMT completes data entryof all forms and submits DHISdata to MoHS by 15th of everymonth

DHMT submits PBF report to LCby 18th of month after quarterend, cc MoHS

LC certifies PBF Report and submitsto MoHS by 30th of month afterquarter end

MoHS approves reports from LCs, compiles andforwards to LGFD by 5th of second month afterquarter end

DHISData

____

PHU DHISforms

InternalVerificationTeam

Supervision andVerificationChecklist

Local Council

PBF Report

Certified PBFReport

Approved andCompiled PBFReport

PBF Payment Disbursement Process

District Health ManagementTeam

Ministry of Health andSanitation

Peripheral Health Unit orClinic

LGFD receives PBF Report and by5th and disburses PBF paymentsto LCs by 10th of second monthafter quarter end

PBF Payment for PHUs andInternal Verification Team

____

InternalVerificationTeam

PBF Payment forPHU

____

PBF Payment for IVT

____

LC disburses PBF payments toPHU and IVT accounts by 15th ofsecond month after quarter end

Local Council

MoFED: Local Govt. FinanceDepartment

LGFD copies disbursementinformation to MoHS

LC copies disburse-mentinformation to DHMT

Report ondisburse-mentto LCs

Report ondisburse-ment toPHUs

Approved andCompiled PBFReport

PBF Financial Record Keeping and Reporting Process

Ministry of Healthand Sanitation

Peripheral HealthUnit or Clinic

PHU submits PBFfinancial report toDHMT by 5th ofmonth after quarterend

LC approvesaggregated financialreport and submitsto LGFD by end ofmonth after quarterend

LGFD approves financial reports fromLCs, compiles and forwards to MoHSby 10th of second month after quarterend

Local Council

PHU PBFFinancialReport

Compiled PBFFinancialReports

InternalVerification Team

IVT submits PBFfinancial report toDHMT by 5th ofmonth after quarterend

AggregatedPBF FinancialReport

IVT PBFFinancialReport

Approved PBFFinancial Report

District HealthManagementTeam

AggregatedPBFFinancialReport

DHMT aggregates PHU financialreports and submits to LC by 15thof month after quarter end,copying MoHS

MoFED: LocalGovt. FinanceDepartment

ConsolidatedInterimFinancialReport

LGFD submitsconsolidatedInterim (un-audited) FinancialReport to WB – IDAby 45 days afterquarter end

Conclusion

The PBF system will not replace the existingstructure of healthcare services, but willcomplement them and increase the healthworkers’ productivity.

Thank you