Download Pillar-level Examination of PRS Implementation: Social Sectors

Ministry of Health & Social Welfare
Experiences in PBF Program in Liberia
Community of Practice Conference
March 18-19, 2011
Saly (Senegal)
By Benedict C. Harris & Dominic Togba
Outline
• Country context
• PBF Policy Development
• Design & Implementation
• Description of Experiences (actors, intervention sites)
• Areas of concern
• Lessons Learnt & Next Steps
Country Context
•
•
•
•
High Maternal mortality: 994/100,000
High Child mortality: 110/1000 (LDHS)
High poverty level (64% below poverty line)
Political stability and economic recovery and
growth:
– GDP: 2008/09 remains constant at around 10%
– Liberia is 7th fastest growing economy in 2009 out of 44
countries
MOHSW Vision & Mission
• Vision:
– 2011: is moving away from the post-conflict mentality to a
vision of “Healthy population with social protection for all”
• Mission:
– “reform and manage the sector to effectively and efficiently
deliver comprehensive, quality health and social welfare
services that are equitable, accessible and sustainable for all
people in Liberia”
PBF Policy
• Increase equitable access health services
• Improve the quality of service provision
• Strengthen national and county support
systems to restore government management of
government health facilities
PBF Implementation Approaches:
Piloted a mixture of approaches :
- Contracting in- one level of government contracts with
another
- Contracting out- a partner is contracted with complete
authority over all resources (human, material and financial) to
provide health services
PBF Design & Implementation
• Contracting In:
– Bomi County Health Team
– Provision of BPHS in 19 health facilities
– Bomi subcontracted with African Humanitarian Aid (AHA) to support provision
of BPHS in 6 facilities
– Amount: USD 2.1 Million (MoHSW Pool Fund*)
– Period: Nov 2009-June 2011
• Contracting Out:
– 5 NGOs (Merlin, AHA, International Rescue Committee, Save-the Children-UK
and Pentecostal Mission Unlimited (PMU))
– Provision of BPHS in 100 facilities
– 5 Counties: Maryland, Grand Gedeh, Nimba, Montserrado and Lofa
– Amount: USD 18.5 Million (MoHSW Pool Fund)
– Period: November 2009-June 2011
*MOHSW Pooled Fund established in April 2010 (with an initial 2-year timeframe) backed with DFID,
Irish Aid and EU financial support
PBF contracts by type of health facility
Type of health
facility
Contracting-out
(NGOs )
Contracting-in
(BOMI CHT )
TOTAL
Clinic
87
19
106
Health Center
8
0
8
Hospital
5
1
6
100
20
120
TOTAL
PBF Budget by County
PBF BUDGET (US$)
COUNTY
Bomi
ORGANIZATION
CHT
AMOUNT
2,118,489
Gbarpolu
AHA
2,326,021
Grand Gedeh
Lofa
Merlin
PMU
4,384,330
2,111,701
Maryland
Merlin
4,335,965
Montserrado / Bong
Nimba
SCUK
IRC
1,268,632
1,520,661
Rivercess
TOTAL
AHA
2,628,488
20,694,287
PBF Key Accomplishments
• PBF Structure:
• Establishment of PBF Steering Committee
• Set up a PBF sub-unit at MoHSW
• Development of policy document and PBF contracts :
• National PBF indicators selected
• PBF targets selected (in progress)
• PBF payment plan and budget developed
• PBF M&E and data verification plan developed
• Capacity building :
• Study tour in Rwanda
• Training of trainers (national and Bomi CHT)
NB: Strong partnership with RBHS/MSH
Constraints
• Implementation constraints:
• Lack of operation/implementation manual and tools providing
guidelines for implementation
• M&E and Data verification mechanism not yet fully operational
• Delay in payment of the performance bonus to providers
(leading to lack of motivation)
• Few people trained in PBF implementation
• Financial sustainability:
• Pool fund : funds available up to June 2011
Lessons Learned
• Retention of HRH in Bomi
• Minimized HRH staff turnout
• Need to have a complete unit responsible for PBF and fully
staffed /capacitated
• Avoid grey areas: Be able to clearly define roles and
responsibilities of stakeholders (providers, contracting agency,
etc)
• Make transactions more efficient; providers performance
bonus needs to be paid more frequently and timely
Next Steps & Dates
• Key activities* (2011):
– Assessment of the PBF institutional and implementation arrangements
– Development of the PBF operational manual
– development of a detailed road map and costing/budget for long term
sustainability
– Conduct training of key implementers:
• TOT (PBF Technical Committee, PBF Unit, NGOs implementing
PBF)
• Training of CHTs: PBF Task Force, Secretariat and validation
Teams
• Training of Health staff (community health dev, committee; staff at
health centers/clinics)
*: with technical support from RBHS and World Bank
Next Steps & Dates
•
PBF scale-up plan:
– Phase 1 (2011): Improve and consolidate existing PBF
programs with NGOs and Bomi CHT
– Phase 2 (2012-13): Extend PBF program to CHTs in 5
counties (where NGOs already operate including RBHS);
Introduce PBF program at the hospital level
– Phase 3 (2014-15): Extend PBF to all counties and shift
NGOs roles to support CHT and health facilities; introduce
Community PBF program
Thank You for Your Attention