PBF CONFERENCE 14 TH -17 TH FEBRUARY 2011 BUJUMBURA, BURUNDI DESIGNING OF Sierra Leone simple performance based financing Scheme (PBF) Presented by Michael.

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)

Outline of the presentation1. 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 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!

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

Outline of Simple PBF Scheme

Start in April 2011, funding available till October 2013PHUs 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

Simple PBF InterventionsThe 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)

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

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 antenatal consultations. 1.4

N3 = Number of pregnant women in labour attended by a health professional, at the facility. 2.4

N4 = Number of women completing series of three postnatal consultations 1.4

N5 = Number of children aged less than 12 months completing national EPI immunization course. 1.4

N6 = Number of outpatient visits of children under five 0.1

Institutional Structure and Agreements

REGULATORREGULATORFUND HOLDERFUND HOLDER

NATIONAL LEVEL

NATIONAL LEVEL

SERVICE PROVIDERSERVICE PROVIDER INDEPENDENT VALIDATORINDEPENDENT VALIDATOR

COMMUNITY LEVEL

COMMUNITY LEVEL

DISTRICT LEVEL

DISTRICT LEVEL

Independent Validation Agency

Contract


Contract

Tripartite PBF Agreement

Tripartite PBF Agreement

District Health Management

Team


Team

PBF Supervision/ Verification Agreement

PBF Supervision/ Verification Agreement

Peripheral Health Unit or Clinic


MoFED: Local Govt. Finance Department


Health Management

Committee

Health Management

Committee


Independent Validation AgencyLocal CouncilLocal Council

Ministry of Health and Sanitation


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)

Key Roles and Responsibilities

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

Key Roles and Responsibilities (cont)

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)

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 toolsPBF implementation starts on 1st April 2011

PBF Reporting, Supervision and Verification Process

MoFED: Local Govt. Finance DepartmentMoFED: Local Govt. Finance Department

District Health Management Team






PHU submits DHIS forms to DHMT by 5th of every month

Joint Supervision and Verification checklist completed and data

entered by quarter end

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

LC certifies PBF Report and submits to MoHS by 30th of month after quarter end

MoHS approves reports from LCs, compiles and forwards to LGFD by 5th of second month after quarter end

DHIS Data

____

PHU DHIS forms

Internal Verification

Team


TeamSupervision and Verification Checklist

Local CouncilLocal Council

PBF Report

Certified PBF Report

Approved and Compiled PBF Report

PBF Payment Disbursement Process







LGFD receives PBF Report and by 5th and disburses PBF payments to LCs by 10th of second month after quarter end

PBF Payment for PHUs and Internal Verification Team____


Team


Team

PBF Payment for PHU____

PBF Payment for IVT____

LC disburses PBF payments to PHU and IVT accounts by 15th of second month after quarter end




LGFD copies disbursement information to MoHS

LC copies disburse-ment information to DHMT

Report on disburse-ment to LCs

Report on disburse-ment to PHUs

Approved and Compiled PBF Report

PBF Financial Record Keeping and Reporting Process





PHU submits PBF financial report to DHMT by 5th of month after quarter end

LC approves aggregated financial report and submits to LGFD by end of month after quarter endLGFD approves financial reports from

LCs, compiles and forwards to MoHS by 10th of second month after quarter end


PHU PBF Financial Report

Compiled PBF Financial Reports

Internal Verificatio

n Team

Internal Verificatio

n TeamIVT submits PBF financial report to DHMT by 5th of month after quarter end

Aggregated PBF Financial Report

IVT PBF Financial Report

Approved PBF Financial Report


Team


Team

Aggregated PBF Financial Report

DHMT aggregates PHU financial reports and submits to LC by 15th of month after quarter end, copying MoHS



Consolidated Interim Financial Report

LGFD submits consolidated Interim (un-audited) Financial Report to WB – IDA by 45 days after quarter end

Conclusion

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

Thank you

PBF CONFERENCE 14 TH -17 TH FEBRUARY 2011 BUJUMBURA, BURUNDI DESIGNING OF Sierra Leone simple performance based financing Scheme (PBF) Presented by Michael.

Documents

pbf fundsministry of

pbf conference

health sector

health professional

quality health services

free health care policywe

number of children

pbf indicatorpbf price