Regional Health Management Team (RHMT) recommended PBF to enhance Performance in Health Sector.

On 28^th June 2012, Rungwe PBF Pilot Project Organized one day meeting for Regional Health Management Team (RHMT)- Mbeya Region and  City Council Management Team Members (CHMT)  at Regional Medical Officer (RMO) Conference room. It was part of Performance Based Financing (PBF) advocacy in the Region and we used the session as an opportunity to give feedback on the project implementation to the participants.

The meeting was officially opened by the Chairman of Christian Social Services Commission (CSSC) Southern Zone after some brief comments by Regional Medical Officer- Mbeya Region.

Thereafter, the Zonal PBF Coordinator made presentations, on PBF as Health Financing Model, and feedback of Rungwe PBF Pilot Project Implementation from 2010- June 2012. PBF) In a nutshell, the presentation contained: Basic Definition PBF, PBF inception in: Asia, Africa and Tanzania, PBF Multi- Country Network, Reasons for PBF to be Popular, Key Principles of Performance Based Financing (PBF), PBF Model on separation of functions. The other part was on Project inception, its objectives, expected output, stakeholders, main activities realized, challenges and achievement .

After the presentation, the participants discussed many issues; which included:

-          Strategies needed to make the decision makers understand the advantages of Output Based Financing against traditional model - input based financing,

-          Signing Service Agreement to lower Level health facilities modalities discussed

-          Delay in fund disbursement for Basket Fund to Health facilities in various Local Governments was briefly discussed. It was noted that part of the cause is delay of reporting as many councils have no specific officer to deal with that. Second, Budgetary sessions need to be amended, as presently the Budget session ends at the end of August, while financial year starts 1^st July.

-          Another issue raised was to reinstate the OPRAS (Open Performance Result Assessment) for her staff in order to increase performance in work place.  This was considered well aligned with Performance Based Financing. It was noted that there is need to have forums to advocated PBF from Lower level to higher level – Ministry, which was expressed as what the Project does.

As a way forward, the participants proposed the following:

-      The responsible authority i.e. Local Governments to work on modalities for lower Level Health Facilities to Sign Service Agreement in Rungwe District.

-      The Project in Collaboration with the financier see ways to incorporate the Regional Health Management team members to be trained on PBF

-      Disseminate PBF through various avenues in the Region such as Regional Health Committee which is the decision making organ.

-      Scale up PBF in Mbeya Region- all districts of Mbeya Region.  Regional Medical Officer indicated that the Region is ready to provide support needed for the scale up process.

From the general observation, it is obvious that the meeting was successful and it made the members enthusiastic, that with the available resources the health Care status in the region could be  improved provided that the financing model  is changed from input to output based financing. Below is the group photo of the participants after the meeting.

 

Council Health Service Board Meeting on PBF commended the Church leaders to mobilize their members for Community Health Fund

On 27^th June 2012 Rungwe PBF Pilot Project organized one day meeting for Council Health Service Board. The aim of the meeting was basically to orient the members on Performance Based Financing (PBF) as one of the health Financing model and secondly to update them on Rungwe PBF Pilot Project.

Moreover, It is worth noting that; Council Health Service Board is the highest Organ in the District responsible for all health matters.  Besides, they are the right people responsible for effecting change at District level on health.  

As a recap, the Zonal PBF Coordinator made a presentation divided into two main parts. The first part was on:  PBF as a Concept then expanded to Rungwe PBF Pilot Project- Project objectives; Project expected results, project stakeholders, and PBF Principles in general.

The second part was on the project implementation, what has been achieved so far, what were the challenges faced the project which so to say was a feedback.

These presentations led to very active discussions which were quite useful and as a response from the Board members. Mainly they are focused on these main issues.

The issue of maintaining quality of products/ medical supplies when you have many suppliers, how to move the decision makers so that they adopt PBF as one of the health financing model as other countries in the PBF network, the need for designing the PBF Project Proposal which will incorporate all the Health facilities in Rungwe District- as the Pilot focus more on the Faith Based Health Facilities.  Other important matters raised in the discussion were to mobilize the church Leaders to educate their church members to join Community Health Fund (CHF). Currently, only Government health facilities are responsible for treating Community Health Fund Members, a situation which several times have made the community members to demand establishing Government health facilities along the Faith Based Organization Health Facilities.

Generally, the meeting was a success in this sense. It enabled the board members to understand basic concepts regarding PBF and they appreciated Performance Based Financing (PBF) as the best model to solve many health issues facing the Local Governments and  one of which  is performance and staff motivation. Secondly, they have come up with ways to improve health facilities under the Faith Based Organization by sensitizing their members to join Community Health Fund and thus do away with out of pocket payment for accessing health Care.

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.

Church Leaders meeting on Rungwe Performance Based Financing (PBF) Pilot Project

Last week on 29^th May 2012, Rungwe PBF Pilot Project organized one day meeting for church leaders in Rungwe District specifically those who own health facilities.  Two presentations were made by Zonal PBF Coordinator on Updates of Rungwe PBF Pilot Project and the second one was on Tanzania Human Resource Project (THRP) by Acting Zonal Secretary. The meeting was held at Catholic Youth Centre in Tukuyu township, and 19 members attended who are: The key officers and the heads of departments.

Moreover, the meeting had these objectives:

- Church leaders understand Rungwe PBF Pilot Project

-  Church Leaders updated on Project progress and challenges

-  Finding ways of applying some PBF principles in other Sectors in the church apart from health

- Church leaders understand Tanzania Human Resource Project, its progress and challenges

After all the presentations, the members gave number of comments, but generally were stirred by Performance Based Financing Approach. They indicated that  the approach if well applied in the church will lead to better results and relieve the church from various cost incurred due to business as usual ways of doing things.

However, after the meeting, the members came up with recommendations and way forward. These are:

-  Church leaders further discuss ways of applying some of the principles of Performance based Financing in various institutions,

-  Introduction of performance assessment for the staff in the church, which could also be two way traffic,

- Church to have business plans which would enable them to be more focused in her mission/ Ministry.

- Investment in the Information Technology and consider as a key element in the church organizations to cope with development in the digital age.

This meeting is considered as advocacy platform for church leaders to discuss ways of improving their organizations, which are faced by issues related to performance. Additionally, it is worth expressing that the church leaders considered PBF as one of the instrument to introduce change in church institutions for the benefit of the people they serve. They frankly pointed out challenges for introducing change in the organizational set up, but were positive that with time and commitment they will succeed, and that is really encouraging! Therefore, the meeting was successful. See the group photo during  the meeting.