Community PBF in Rwanda

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 The Community PBF started in January

2006, in all districts of Rwanda, with funding throught the local administration

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.

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

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)

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

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

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

www.pbfrwanda.org.rw/siscom

Mécanisme contractuel entre acteurs

Financement forfaitaire d’un seul résultat trimestriel: Rapport des ASC avec suivi spécifique de 5 indicateurs (Modèle national)

Community Health Information System Data Flow Chart

CHWs MotivationCHWs Motivation• Trust and respect from community

members, leaders etc…

• Support from Supervisors and implementation partners help improve work;

• Regular trainings, meetings supervision

• In-country study tours to learn from peers in other districts

• Distance learning

• Community performance-based financing (PBF);

• Membership in cooperatives for income generation

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

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

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

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)

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

HE Paul KAGAME with all CHWs

Merci