District PBF Forum advised Local Government to respond to high health facilities utilization as a result of Service Agreement.

Rungwe District PBF forum serves as Public Private Partnership forum in Rungwe District. Its members are drawn from the Local Government leaders, the church leaders, the community representatives and the Health facility representatives. This time, the forum was held on 21^st June 2012 at Catholic Youth Centre with the objective of updating the members on the project implementation since they met last time in December 2011. A total of 13 people participated actively in the meeting.

The forum was opened by Chairman of Zonal Policy Forum Bishop Rev. Dr. Israel- Peter Mwakyolile.  In his opening speech he emphasised the need for coming together as partners. He elucidated the benefits of the dialogue between partners in the district, which resulted into signing of Service Agreement (SA) between two church hospitals and Local Government- Rungwe District Council.  Despite the challenges on the implementation of the Service agreement, the hospitals are providing services to the community.

He further expressed the very positive response from the target groups earmarked: the pregnant women and under five children to utilize the services.  On one side, it is quite good, that the service utilization is so much increasing, but on the other side, the health facilities are overwhelmed by such overflow from the targeted groups. So, that is an indicator which needs to be worked on by the Government to improve health care.

  

He reminded the members to work hard and diligently to apply PBF in the health Sector, so that other people from other areas could come to learn application of Performance Based financing, which will be reflected by service Provision in the facilities within the District.

The Zonal PBF Coordinator made presentation on the Updates regarding the project. The update included feedback on International Conference on Performance Based Financing (PBF) in Dar-Es-salaam, from 6^th- 7^th March 2012, the objective of the meeting was explained, the participants profile, the output of the meeting and the statement read by ministers as commitment  for PBF in the respective countries. Other two meetings output were presented which included: Church Leaders Meeting, Local Government Leaders Meeting. The Later was held as part of advocacy for PBF in the District and really served the purpose.

However, the updates stirred participants to raise questions. But they focused on Government efforts in adopting PBF as health financing Model, critical assessment of service Agreement signed between two church hospitals and Local Government. The other matters raised was the sustainability of the forum which brought public and private together for open discussions on matters related to health in the district, again, the  issue of how the PBF elements are manifested  in Rungwe Districts health facilities. Over and above the question of community members establishing Government health facilities along the church health facilities was also raised,

The issues raised were responded accordingly as follow:

The project is engaged in various Advocacy meetings in the Zone, and the CSSC Head office is doing at National level. As an example the PBF National Conference held in Dar- Es-salaam in March 2012 was efforts of the organization with donors to bring policy makers accept PBF in the health Sector by learning from other countries in the network where PBF is a national Policy(Rwanda, Burundi).

On critical assessment of Service Agreement, the Project has planned the stakeholders meeting for the aim of evaluating the Service agreement between two hospitals and Local Government- Rungwe District Council for Improvement.

As a response to sustainability of District forum, the Local Government Authority will be advised to maintain the forum, and hopefully they will agree as the Public Private Partnership is one of the government strategies in Health Sector.

The active facility Governing Committees (FGCs) in the management of the health facilities can be taken as one element of how PBF works in the District especially to the earmarked facilities. However, the peculiarity of the Project was clearly expressed to the members- as fund for buying indicators is the key for project to implement PB.
Again, the church leaders were asked to mobilize their members for Community Health Fund (CHF) around the church health facilities they become collection centres. currently only public facilities are centres for Community Health Fund(CHF) 

After the discussions, the members came up these recommendations:

-      The Church Leaders write a letter to DMO- Rungwe for appreciation for staff secondment to Itete and Igogwe hospitals (12), which will emphasize the need for more health staff in the health facilities as the Service Agreement has motivated the community members for utilization of health services.

-      The Zonal PBF Coordinator Communicate with the CSSC Headquarter to know the results of the International Conference held in March 2012 in Dar-Es-salaam. Also, the reaction from Ministry Of Health and Social Welfare.

-      The Zonal PBF Coordinator Communicate with the District Executive Director for  Rungwe District so as to use the District PBF forum as Public Private Partnership forum in the District with some improvement.

-      The church Leaders Contact District Medical Officer (DMO) – Rungwe to intervene on the construction of the health facilities along Voluntary Agency Hospital/ facilities by mobilizing their members to be Community Health Fund (CHF ) members.
As we implement the Pilot project, we are realizing the need to incorporate other components in this case- Community Health Fund which can contribute towards Health Services utilization in the catchment areas.

Public Private Partnership taking roots in Rungwe:

On 14^th June 2012, Rungwe PBF Pilot Project organized a one day meeting for local Government Leaders in the District.  This meeting had two objectives: Introduction of general Concept- Performance Based Financing as health financing model, and secondly to give feedback on project implementation in the District.  It was held at DMO Conference in Tukuyu.

It was attended by the key  Local Government officials from Rungwe District Council: The Chairman of the District Council, the District Executive Director, the Chairman of the Social Services – Rungwe District Council and heads of Departments.

It was officially opening by District Executive Director- Rungwe District Council who noted that: the Council as stakeholder in this project has potential roles: regulate policies, guidelines as set by the Government. He added that EU and Cordaid financing this project in Rungwe has enabled the Public Private Partnership in the District which is quite important. Then he thanked them for their financial support.

He argued the participants to take actively participation in this meeting so as to clearly understand this concept on health financing and apply some of the elements in the District, and get the feedback on the project implementation so as to know what is being done and be in a position to advice the Project for improvement.

After the official opening, Zonal PBF Coordinator made a presentation which was basically divided into two parts: Part one was on the Basic Concept on Performance Based Financing as one of the model in Health care Financing, and the second part was on the feedback for project implementation( showing success, challenges and some recommendations)

As a general impression, the participants were stirred up by the benefits which so far the model will have on the health Care as opposed to traditional health financing model I.e. input based financing which is commonly applied in Tanzania.

The participants objectively discussed ways of improving the Voluntary agency Health facilities especially those at Lower Level- Dispensaries and Health Centres.

Below are some of the proposal for such improvement.

-     - Service agreement with the Local Government, in this case Rungwe District Council.  It was apparent from the discussion that there is no such modality, as these facilities have no trained staff to handle funds from basket fund. However, this proposal was taken as part of the solution for addressing the prevailing shortage of: Drugs, medical supplies and human resource for health. Additionally,, the other side of the agreement was also probed- delay in funds disbursement from the Government was noted as another impediment for making the lower health facilities provide health services to the population. Nevertheless, it was taken as a lesser evil option, and members advised the project team to find out modalities from other Councils in the region which has such experience.

-    The issue of improving relationship for Local Government and Church Leaders was another hot issue. It is worth expressing that, through the District Medical Officer (DMO) of Rungwe District Council, the trained staff have been seconded to the Voluntary Agency Health facilities, but it was learnt that for some reasons, these staff normally take short period before going back to their employer- Rungwe District Council. From October 2011 to date, the District Council has seconded 12 health staff to church Health facilities. We can see that this is the beginning of the collaboration and it is hoped that more support will be availed to the church health facilities which have entered service Agreement with the Local Government.

The participants viewed situation facing church health facilities located mostly in rural areas from objective viewpoint. They raised some solution which will be further worked on for improving health care for the  people in the rural areas.

As a conclusion, we can see that the Collaboration between the  Public and Private Partnership in health care through Rungwe PBF Pilot  is getting more roots and definitely would need support from all parts.