home grown incentives in katete district harrison mkandawire district director of health katete...
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Home Grown Incentives in Katete District
Harrison Mkandawire
District Director of Health
Katete District
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Katete at a glance
Population: 233,582 (CSO-2000)Health centres: 26
One general hospital:1Trained staff: 86%
Number of CBHCP: 2,462District grant: K406,341.932
MBB District
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Why we Introduced Incentives
• Health Care workers paid salaries that are not linked to output or outcome measure
• High maternal mortality ratio
• High infant mortality rate
• More deliveries taking place at home
• Focus was on input or processes
• High CBHCP turn over
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Anchorage
• Results based planning
• Results based management
• Participatory Planning
• District Health system strengthening
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PPP
• CIDRZ
• CHAMP
• LWF
• CARE INTERNATION
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The home grown incentive mechanisms:
• rewarding institutions for actual not promised performance
• linking funding to the quantity of outputs or the quality of outcomes rather than inputs
• using performance indicators that reflect public policy objectives rather than institutional needs
• designing incentives for institutional improvement, not just maintaining status quo
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Why Incentives for Health Workers
• Link Incentives to performance
• Hold them accountable for the results
• Change their mindset
• Accelerate the attainment of health related MDGs
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Indicators to be attained
• Institutional deliveries
• Fully immunised children
• ITN utilisation
• IPT Coverage
• Pit latrine coverage
• Contraceptive uptake
• PMTCT
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Incentives for TBAs
• K100,000 ( Thirty Dollars )
• Chitenje material
• Bicycles
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Incentives for clients
Mama kit- those who deliver in the facilityBaby Kit for post-natal- 6 days, 6 wksFood for Ante-natal clients and Under five
clients Food for clients who attend outreach
sessions
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Financial incentives for Health workers
• Floating Trophy
• K1,000,000 for the best performing health centre
• K800,000 for the facility for achieving the target
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Source of Funds
• 10% community allocation from the district grant
• 4% replacement of the lost user fees
• Child health and Maternal Health allocations
• Community Development Funds
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Reorientation of CBHCPs
• Galvanise efforts towards MNCH
• Retrained CBHC
• Use of RDTs at Community level
• Use of Coartem at Community level
• Use of Amoxy at Community level
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Other Innovations
• Bicycle Ambulances• Community HFRs• Transport for the Dischargees from the hospital
and the deceased • Solar panels for staff houses• All centres have motorbikes• All centres have HFRs• Detached delivery rooms• Display of imprest allocation to health centres• 100% disbursement of imprest to health centres
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Innovations cont….
• Motor bikes for all health centres
• Imprest schedules distributed to Health centres, Health centre chairpersons councillors and Members of parliament
• K300,000 local retention allowance
• Collection of school children for the members of staff in hard to reach areas
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Management benefits
• Management latitude
• Innovativeness
• Development of teams cohesion
• Team accountability
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Challenge
• Increased attendance in health centres
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Sustainability
• Use of the local resources
• PPP- Dunavant Cotton Company
• Participatory planning
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Conclusion
• Need to increase the coverage of selected MNCH services to reach the MDG
• Ineffective incentives faced by both providers and households hinder achievements of health outcomes.
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THANK YOU FOR YOUR ATTENTION.