CSSC team on Study Visit to HDP Rwanda

The team from CSSC (PBF Coordinator- Ms. Madina Mukulu and Mr. Sule, T.Michael- Zonal PBF Coordinator) paid a study visit to HDP Rwanda for one week – from 27^th November to 3^rd December 2010. The aim of the study visit was basically to learn on Community participation.  So that we replicate the best practice to the Rungwe Pilot Project in Tanzania; as PBF Rungwe Pilot Project has just recently established facility governing Committees who represent the community in health Care management.

The study tour was preceded by one day discussion on the subject matter with Mr. Christian Habineza in HDP office.  The discussion laid a strong base for the conceptual framework and the real art of doing it including the challenges experienced.  The second day i.e. 30^th November 2010, we visited Gikomero Health centre, and met the acting In charge, Mr. Samwel, who took us around the health centre; which so to say according to our standard is very clean, well kept environment and really PBF Model.  It was a double coincidence of good luck as our Visit coincided with the national campaign on vaccination and malaria control program. That means, It was easy to meet responsible community representatives.  In Gikomero, we managed to have brief meeting with members of the Cooperative.  Really, they are working hand in hand with the health facilities as upon our arrival; they were assisting the health staff in counter checking the names of the people for bed nets distribution, while some were doing cleanliness around the health facility.  Moreover, we went to the outreach, under Gikomero Health centre, and found that the three health staff working diligently with the community members after the Health committee done their mobilization job.

Our Last field day was on the North- Gisenye District border of DRC.  There we managed to visit one health centre, by the name of Nyundo, and as usual, the staff were involved in the campaign and they explained to us the same experience of working closely with health committee and cooperative.

On Thursday, we had some discussion with Mr. Christian on Community Based Organization as part of Community participation.   Here, he shared with us how they involved the CBO in various counter checking.  Furthermore, he noted that HDP has initiated the move for CBOs to have a federation; which carry out validation on professionally level. 

Again, we discussed indicators developed by PBF Rungwe Pilot Project for performance assessment- participatory Monitoring and evaluation.  Also, Mr. Christian shared with us experience of bonus payment on pure PBF in Rwanda context.

Lastly, our study tour was culminated by paying a visit to Kigali Memorial centre.  Here we were accompanied by Mr. Alexis.  As usual, we had brief introduction at the reception and later we had a tour to three major units: the main part showing events that took place,the  second part documented children unit and the last one was the general world genocide- which included the Holocaust, Darfur and some from Balkans.The big lesson learnt was that Peace has a high Price.

Lesson learnt from our study tour:

First, there is strong collaboration between the health facility and community through health workers cooperatives

Second, the facility team is well organized, and probably is due to information sharing amongst the staff.  Again, the facility environment is quite neat and clean. 

Third, the data is well arranged at the facility to the extent that it is easier for counter checking purposes.

Fourth, the feedback meeting between the facility staff and cooperative members promotes customer care.

Fifth, the involvement of the community in provision of some services e.g. distribution of mosquito nets reduced the workload of the facility technical team who are focused more on technical matters.

However, the cooperatives members are faced by these Challenges: They are lacking adequate working tools such as:  boots, torch and even transport facility.

Lastly, it is worth noting that we had wonderful reception by HDP team.  They provided us all the assistance we needed from the first day till the last day of our visit.  We thank them All. Long live HDP Rwanda!!See the photo below.

               

CSSC team in a  group photo with some of

HDP staff.  From right to left: Mr. Theo, Mr. Sule,

Ms. Madina, Mr. Gaspar and Mr. Alexis.

Supportive Supervision to Health Facilities

During this quarter, the project made a supportive supervision to health six facilities in PBF Rungwe pilot area.  The team involved CSSC PBF Coordinator- Ms. Madina Mukulu and Mr. Sule, T.Michael Zonal PBF Coordinator for Rungwe PBF Pilot Project.  In the the supervision, the team used for the first time the jointly developed Participatory Monitoring and Evaluation indicators; which were developed for performance assessment.  The visit took two days i.e. from 1^st November to 2^nd November 2010.  The facilities visited included the following:  Ntaba Dispensary, Kasyabone Dispensary and Itete Hospital.  Others were Tukuyu Health Centre, Rungwe Mission Dispensary and Igogwe Hospital.  From the questionnaire, it was found that the Health facilities are doing well with exception of the (Health Management Information System, famously called MTUHA Books.  There is a mix of stories.  First, the facilities are lacking one important book: Book 10, where they summarize the data for the quarter and send the original document to DMO.  Second, the majority of staff in the visited health facilities were not trained on filling MTUHA. Again, there was a problem on the ledger for the medicines and medical supplies- they are not updated regularly.  In addition to that, the issue of HRH was seen as quite overwhelming in most of the dispensaries visited.  Definitely, it was due to the fact that the staff personal files either remains at the employer office- in this case the General Secretary or at the hospital level to Doctor.  At least that was easy to rectify as we agreed upon facilities having the copies.

From the general assessment made, the management of the facilities visited understood the need to improve these jointly developed for participatory Monitoring and Evaluation indicators.  Most of these were in their capacities.  However, each part understood the need for improvement.

Community Participation in Community Water Management, 978-3-8433-6977-0, 3843369771 ,9783843369770 by Theophil Michael Sule

Community Participation in Community Water Management, 978-3-8433-6977-0, 3843369771 ,9783843369770 by Theophil Michael Sule

Dear ALL,
Please have a look to my newly published book.

Facility Strategic Planning with Community Representatives

PBF Rungwe Pilot project conducted an important event during this last quarter i.e. October 2010.  The event was training six health facilities in charges and community representative on Strategic Planning.

The training started on 25^th October and concluded on 30^th October 2010, and held at RC Tukuyu Youth Centre where PBF Zonal Coordinator Office is based.   The training was facilitated by Fr. Lukas Komba, Ms. Helga Schneider, Sule, T. Michael and Madina Mukulu.

To start with Fr. Lukas gave a presentation on Strategic Plan, taking them careful step by steps and with examples and illustrations.  This kind of approach – learner centred was quite effective and simple for people who have no much experience on such exercises i.e. Strategic Planning.

As the facilities were from three main denominations i.e. facilities under Roman Catholic, Lutheran Church and Moravian Church.  So, the groups worked on those lines, in other words, Itete hospital team supported Ntaba Dispensary team and Tukuyu Health centre team.   The same situation was for Igogwe hospital team which kindly supported Kisa Health Centre. However, Rungwe Dispensary which was under the Moravian Church of Tanzania- Southern Province work on their own. A total of 17 people participated in the training for 6 days, and considered very peculiar even for PBF Project.  Then, what made this training so unique!

Community representatives developed strategic Plan with in charge of the health facilities.  Normally, such exercise is regarded as academic and for people with very formal training.  Second, the collaboration instilled the sense of ownership to the community representative as commented by one member at the end that’’ Really we have benefited through the training and have realized that we are part and parcel of the health facilities, we will involve the people in supporting Health facilities’’.  It was obvious that through group discussions, the members understood the vision, missions, values, strategic Goal, strategic objective, and specific objectives of their health facilities, which was developed after carrying out the Analysis (SWOT, PEST and Stakeholders). 

The methodology applied during the training was user friendly.  Lecture, group discussion and group work. That means, there were brief presentations, which were internalized through group works and presentations and followed by discussions for clarification and improvement.

When we started the training, the work seems quite hard.  But with perseverance we managed to go from one step to the other until Saturday on 30^th October when we managed to complete most of the areas in strategic planning. Some pending areas were agreed to be accomplished within ten days period. Again, the groups refined their works into hospital operational plans, which is based on one year for Service Agreement purposes.

Basically, strategic planning training aimed at Capacity building for Health Facilities, and enable Health facilities to have a document which will be used for negotiation with the Local Government on service Agreement. This is aimed before the end of the year i.e. 2010.  In addition to that, five facilities out of six facilities are through with Costing for their operational cost; and Competence Centre of CSSC is working on the data.  Definitely, having these documents in place, we are hoping for the hope that the Church leaders in collaboration with CSSC will be in a position to negotiate with Rungwe District Council for Service Agreement for these facilities in 2011. See the Photo of the Group members below.

Fr. Lukas presenting a Strategic Planning to the

Participants from six health facilities on 25th Oct.2010.

Performance Based Financing-Rungwe Pilot: PBF Forum in Rungwe District August 23rd 2010

Performance Based Financing-Rungwe Pilot: PBF Forum in Rungwe District August 23rd 2010

PBF Rungwe Training was a Success!!

PBF Rungwe Pilot project conducted successfully ten days training on PBF  in Rungwe from 27^th September to 7^th October 2010.  The training venue was at Catholic Youth Centre, located in Tukuyu township, about 1. 5 km from Tukuyu town centre. The training involved 14 health staff under FBOs facilities and 6 health staff under DMO office- total 20 participants.  The training had three (3) objectives; these were: To provide participants with an understanding of the relationships between national policies, health policy and economic policies and how they are influenced by Performance Based Financing.  The second objective being to understand the objectives, theories, best practices and instruments of Performance Base Financing and the last objective was to provide participants with knowledge and skills to enable them to improve the implementation of PBF in their settings.  The training was coordinated by facilitators from KCMC, ETC-The Netherlands, HDP Rwanda, MOHSW and from CSSC- Competence centre. Moreover, the training was colorfully opened by the DMO Rungwe District – Dr. N. Sungwa. In his speech, he thanked EU, Cordaid and CSSC for choosing Rungwe to be the pilot area for PBF project.  He added that, the district is proud of the project and working in collaboration with the project so that it becomes successful.  Moreover, he explained that this is a new concept in Rungwe.  He added that some three years back the government introduced similar project called P4P, which unfortunately was not successful. He promised that the Government is eagerly learning PBF in order to make it successful and thus improve health services provision in Rungwe district. He emphasized that, besides being new, PBF approach has appeal to the government as the right approach in improving health services delivery. Finally, he urged the participants to be attentive and inquisitive during the training as they will definitely be trainers to their peers in the District. Additionally, on Service Agreement he pointed out that the government is doing all it can to have service Agreement in the district, though the process would take some time. Moreover, it is worth noting that this training was blessed to have three key facilitators. The first one was Mr. Christian Habineza from HDP- Rwanda.  During the training he shared his extensive experiences on implementing PBF projects in Rwanda and presented best practices through case studies.  To a great extent, that was quite important as the participants realized that it is all possible and that PBF is a practical Health financing model. Another trainer was   Dr. Albert from the Netherlands who is an international consultant. His rich experiences on East Africa  health care services was a great asset to the training in general  and his knowledge on  PBF in Particular added value to the training.  The above combination enabled the participants to grasp normally considered very academic lessons on: Socio- Economic Policies, Micro-Economics, Entrepreneurship of health facilities, understanding Costs, Comprehensive Council planning and Linking PBF with Service Agreement into practical issues on health. And the last one was Dr. Anna from MOHSW. Her participation added weight to the training, that the Government and in particular the Ministry of Health and Social Welfare (MOSHSW) is supporting PBF as health financing Model in the Tanzania.  She presented two topics:  Tanzania Health Sector Reform and PPP. In total 24 topics were presented during ten days PBF Rungwe training.  It was noted during daily evaluation that the training need to be customized as there are areas which need more refining to suit the environment.  Generally, the training was quite successful as indicated in the final evaluation and the training objectives were met.  Now, the pilot area i.e.  Rungwe District is getting more PBF pioneers and supporters.  They are expected to bring changes in their facilities. See photo below.                            

PBF training Participants group photo after official opening- Seated on the

Front line is the Guest of honor-DMO Rungwe,Dr. Sungwa(in the Middle),

 Dr. Manongi – Course to the right side, Chairperson for the Course to the

 Left  Mr. Christian on the far right corner

Performance Based Financing-Rungwe Pilot: PBF Forum in Rungwe District August 23rd 2010

Performance Based Financing-Rungwe Pilot: PBF Forum in Rungwe District August 23rd 2010

Facility Governing Committee establishment and Training

It is a pleasure to express that, PBF Rungwe pilot project has enable all 12 health facilities under faith based organizations in Rungwe to establish Facilities Governing Committees.  This was a result of PBF inception meeting recommendations in June 2010, despite being in the Action plan for the project for the first year i.e. 2010.  Now each health facility has a facility Governing committee. In regard to gender representation, at least one third are women.  Moreover, the committees are all trained on their roles and responsibilities plus the basic concepts on PBF. The training took three days in total in three zones: The first zone included five health facilities around Tukuyu area, whereby the training was held on 16th Sept 2010 at Tukuyu Youth Centre, and the second zone was in Mwakaleli, about 40 km away, whereby three facilities had one day training at Mwakaleli centre and was held on 17th Sept 2010.  The third and last zone was for four health facilities around Itete about 45 km away from Tukuyu township.  The venue was at Itete hospital and was conducted on 18th Sept 2010.  The trainings were facilitated by:  Zonal PBF Coordinator and Mr. Japhet Kalindu who is a Zonal trainer for facility Governing Committees.  The training enabled the facility governing committees to better understand their roles and responsibilities in managing health facilities.  It is my hope that they will be an important link for community voice in health services delivery in the facilities. See the group photo for the facility Governing committee training held in Tukuyu.

                                                    Group photo of the trained facility Governing Committees from 5 facilities on 16th Sept 2010.

PBF Forum in Rungwe District August 23rd 2010

Dear ALL,

 Please welcome to PBF Rungwe Blog.  I will be posting various information regarding the project from time to time.  Last month we had a PBF forum which involved stakeholders- who are high level officials from Church, Local Government and community representative from Rungwe District Plus the doctors in charge from hospitals.  Essentially, it was a platform for PPP establishment.  The members discussed various issues including Service Agreement  arrangement in the District. Please see the Group Photo during discussion session.