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
Independent Validation Agency
Contract
Tripartite PBF Agreement
Tripartite PBF Agreement
District Health Management
Team
District Health Management
Team
PBF Supervision/ Verification Agreement
PBF Supervision/ Verification Agreement
Peripheral Health Unit or Clinic
Peripheral Health Unit or Clinic
MoFED: Local Govt. Finance Department
MoFED: Local Govt. Finance Department
Health Management
Committee
Health Management
Committee
Independent Validation Agency
Independent Validation AgencyLocal CouncilLocal Council
Ministry of Health and Sanitation
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
District Health Management Team
Ministry of Health and Sanitation
Ministry of Health and Sanitation
Peripheral Health Unit or Clinic
Peripheral Health Unit or Clinic
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
Internal Verification
TeamSupervision and Verification Checklist
Local CouncilLocal Council
PBF Report
Certified PBF Report
Approved and Compiled PBF Report
PBF Payment Disbursement Process
District Health Management Team
District Health Management Team
Ministry of Health and Sanitation
Ministry of Health and Sanitation
Peripheral Health Unit or Clinic
Peripheral Health Unit or Clinic
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____
Internal Verification
Team
Internal Verification
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
Local CouncilLocal Council
MoFED: Local Govt. Finance Department
MoFED: Local Govt. Finance Department
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
Ministry of Health and Sanitation
Ministry of Health and Sanitation
Peripheral Health Unit or Clinic
Peripheral Health Unit or Clinic
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
Local CouncilLocal Council
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
District Health Management
Team
District Health Management
Team
Aggregated PBF Financial Report
DHMT aggregates PHU financial reports and submits to LC by 15th of month after quarter end, copying MoHS
MoFED: Local Govt. Finance Department
MoFED: Local Govt. Finance Department
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