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Slide 1 - Performance Based Financing

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					  CHAZ PBF Experience

PBF Conference for the Multi-country
     network held in Burundi
     14th – 17th February 2011

                Churches Health Association of Zambia
                Box 34511, Ben Bella Road, Lusaka, Zambia
 Phone 260 1 229702/237328, Fax: 260 1 223297, Cell: 0979568292/0977790499
                         Email: ed@chaz.org.zm
                       Website www.chazhealth.org
•   He sent them to Preach the Kingdom of God and Heal the sick ” Luke 9:2
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CHAZ Background Information
Formation & Membership
• Formed in 1970 ( Catholic and Protestant Medical Committees)
• Interdenominational (Catholic and Protestant) umbrella organisation for
   146 CHIS in 9 Provinces and 56 Districts (out of 72):
    •   36 Hospitals & 81 RHCs & 9 Training Schools
    •   29 CBOs: 20 Community Based Programmes & 9 Catholic Dioceses

Health Services Coverage
• CHAZ is the second largest provider of health services in Zambia.
• MoU with the MoH: 75% Grant, 90% Staff , 90% Essential Drugs

Principal Recipient Status
• PR for the Global Fund Mechanism in Zambia for all the 3 disease
   components: HIV/AIDS (including ART), Malaria & TB.
Others
• Recipient of the Joint Financial Arrangement (JFA)
• One of the major PBF implementers in the country
                “He sent them to preach the Kingdom of God and heal the sick” Luke 9:2
Project objectives
Overall objective
The overall purpose of the PBF project is to safeguard health sector performance and
   contribute to the achievement of a better health status of the Zambian population.
Specific Objectives
• To build capacity among church health and government institutions and the CHAZ
  secretariat for the gradual introduction of performance based financing
• To document experiences, conduct action research and share lessons learnt on PBF
  and its various dimensions
• To promote effective community participation in relation to PBF
• To actively take part in the international network of exchange (community of
   practice) on PBF that is unfolding.


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                 Project Expected Outcomes
1. The voice of the client is strengthened.

2. Improved CHAZ capacity to expand and promote PBF independently

3. Actively piloted PBF strategy in government and mission facilities in two
districts

4. Harmonised of the PBF approach between CHAZ and MoH


5. Local capacity built in training on PBF




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                 History of P4Pin Zambia
In 3 Dioceses (Mansa, Mpika and Chipata) 6 hospitals, 7 health centres
        Mansa Diocese: (started 1-1-2007),St. Paul’s Hospital, Lubwe
        Hospital, Kasaba Hospital, Health desk

       Chipata Diocese
       Minga Hospital (started 1-1-2007), Lumezi Hospital
       (started 1-1-2008),     Kanyanga HC (started 1-1-2008), Muzeyi
       HC (started 1-1-2008), Health Desk (started 1-1-2008)

       Mpika Diocese:
       Our Ladies Hospital (Chilonga) (started 1-1-2007), Chalabesa HC,
       (started 1-7-2008), Mulanga HC (started 1-7-2008)Ilondola HC
       (started 1-7-2008), Mulilansolo HC (started 1-1-2009),Health
       Desk (started 1-7-2008)

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              “He sent them to preach the Kingdom of God and heal the sick” Luke 9:2
                          P4P Evaluation
•Evaluation was done in the 3 dioceses
•Revealed both positive and negative outcomes
•Recommended the involvement of a local
stakeholder (CHAZ) in project management
•Extensive involvement of the stakeholders in health
•Identified a need for a pilot on proper PBF
interventions
•Use of a more contextualized approach in the
design process

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          “He sent them to preach the Kingdom of God and heal the sick” Luke 9:2
          The CHAZ PBF Pilot Project
•   2 districts selected for PBF piloting
•   Selection based on a set criteria
•   EU Funded PBF is a multi country project,
•   Pilot implemented in 3 years from Jan 2010 – Dec
    2012




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         Implementation strategies
Seven core strategies will be employed to implement the project:
• Actual (co-)financing of (health) services based on past
  performance, through the conclusion of service agreements for
  church health institutions
• Capacity building
• Exchange visits and peer review
• Action research
• Site visits for monitoring purposes
• Consultation at national, district and community level
• Documentation and dissemination


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            CHAZ INVOLVEMENT

• Following the recommendation for CHAZ involvement in
  P4P
• In July 2009 CHAZ studied the P4P situation and
  sensitized the stakeholders on PBF development
• Advocacy for PBF to all stakeholders
• Developed institutional framework (WB, UNZA, MoH,
  DHMT)
• Shared PBF strategies with the TWG-MoH
• TWG accepted the CHAZ PBF strategy
• Selected districts shared with MoH
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        Pilot District Selection Criteria
•   Rural district
•   Church presence (in view of Govt/FBO collaboration), in particular:
    the number of hospitals and h/centres and share of churches’ catchment
    population as a % of total district population
•   P4P history (with Cordaid)
•   Not an RBF district (intervention or control district) in the WB supported
    project
•   Workload in terms of staff/contact ratio: preferably average (neither high nor
    low)
•   Disease burden: child malnutrition (% underweight), pneumonia, %
    institutional deliveries
•   Catchment population served by church health institutions: ideally not more
    than 100,000.

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District Selection
Selection Cont’n
CHAZ /PBF Implementation Structure
The project emphasizes on split of responsibility
• Fundholder Agency - CHAZ
• Regulator – quality standards - DHMT
• Local Purchasing Agency – responsible for contracting -
  ZSIC
• Local Verifier Organisation– client satisfaction surveys
• Health facilities – DOPE and DAPP
• Community organizations/committees – NHC, HCC,
  HAC

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                     Verification procedure
Quality
•   Done by local quality experts with performance contracts
•   Follow agreed upon quality standards
•   Give a score expressed in percentage
•   Quality will determine the absolute score (rewards =Quality*quantity*performance
    index)
Quantity/data verification
•   Conducted by the LPA - ZSIC
•   Produces provisional invoices based on data results
Client Tracer surveys
• Conducted by a locally based NGO – contracted
•   Results inform the next quarter business plans for the facility
•   In future, survey results will determine
Invoices
•   Are consolidated by the PBF district steering committee
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                      Where are we?

• Project design finalized
• Actual implementation commenced in July, 2010
• Baseline survey conducted
• Desk review on existing levels of performance contracting in CHAZ
• Performance verification for quarter three (2010) conducted
• Project implementation manual
• Capacity building activities for policy makers and implementers
• Collaboration with other stakeholders - Trainers, LPA, Local verifier
  organizations
• Shared experiences with stakeholders in the country


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Selected Indicators/ costs




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Quarter 3 (2010) results




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Sustainability plan for the CHAZ PBF scheme:

•Involvement of other critical stakeholders (Local purchaser,
Community organisations, MoH, UNZA)
•Member of the TWG-HCF and the PBF national steering committee
•Transparency about PBF-funding / Inequity
• Intergrated planning and reporting for PBF
• Community involvement – possible gradual intriduction of pre-
financing schemes
•Gradual intergration of PBF into the routine CHAZ program
management                                                                             20
              “He sent them to preach the Kingdom of God and heal the sick” Luke 9:2
Thank you for your attention




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