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Empowering Health Workers_Sarla Chand_10.17.13


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Empowering Health Workers_Sarla Chand_10.17.13

  1. 1. Performance Based Financing Rapid Results Health Project In South Sudan Dr. Sarla Chand & Dr. William Clemmer Core Group Fall Meeting October 16-17, 2013
  2. 2. Our History • Founded in 1960 as “Interchurch Medical Assistance” • Founded by 6 Protestant mission organizations • Purpose: Procurement and distribution of medicines and medical supplies to medical missions all over the world • Today: IMA has grown to manage our own health and development programs in Africa and Haiti 1960 Today 2
  3. 3. Core Competencies • Health Systems Strengthening (HSS) – Rebuilding the health system in nations especially those recovering from war, disaster, and struggling with poverty • Capacity Building – Empowering and partnering with local governments, partners, faith-based organizations, and health workers to strengthen health services delivery • Disease Prevention and Control – Control/elimination of HIV/AIDS, Neglected Tropical Diseases (NTDs), malaria, and Non-Communicable Diseases (NCDs) such as cervical cancer and Burkitt’s Lymphoma(childhood cancer) • Procurement and Distribution – Cost effective, expert supply chain management with strategic global distribution of over $1 billion in medicines and supplies to date 3
  4. 4. South Sudan Landlocked Population: 10-13m Young Population: 72% under 25 years
  5. 5. 32 Years of Civil War • 2.5 million killed • 4 million displaced • Health care system collapsed • Weak education system/low literacy • Weak Infrastructure July 9, 2011 Independence Day
  6. 6. SCOPE of Rapid Results Health Project Two States – UN & JG Twenty Four Counties 284 Health Facilities 3.1 Million Persons $7.40 per capita investment
  7. 7. PBF/PBC • PBF…….performance based financing – ‘PBF’ we mean programs including incentivized payments, additional financial resources, reinforced supervision and increased managerial autonomy. – ‘PBF’ is financing that shifts attention from inputs to outputs, and eventually outcomes, in health services.. – Pay-4-Performance • PBC……performance based contracting ( tool) – PBC is the tool to operationalize forms of Performance Based Financing
  8. 8. Implementation Timeline for PBF/PBC January 2013 January 2012 July 9, 2011 October 2010 PBC with CHDs Independence Oil shutdown PBC with HFs
  9. 9. Performance Q1 JG State
  10. 10. • Results in Jonglei State ( 1st 6 months)
  11. 11. • Results in Upper Nile State (first six months)
  12. 12. Incentives and Ante-Natal Care • • • • RBF…… PBC…… PBF……. IBF…….. Incentives and Ante-Natal Care Performance P-Values - UN: < 0.0001 and JG: < 0.0041
  13. 13. Incentives and Curative Care for Under-Fives • • • • RBF…… PBC…… PBF……. IBF…….. Incentives and Curative Care for Under-Fives P-Values - UN: < 0.0018 and JG: 0.9034
  14. 14. Incentives and DPT3 • • • • RBF…… PBC…… PBF……. IBF…….. Incentives and DPT3 Vaccinations P-Values - UN: < 0. 7374 and JG: 0.9727
  15. 15. Conclusions/Recommendations 1. 2. 3. 4. 5. 6. 7. 8. HMIS Reporting from County Health Departments (CHDs) continues to be high Q2 has shown an increase in payment (50% to 70%) to health facilities Facilities noted that the PBC payment often made the difference between the facility being open and closed! (they could depend on being paid) Open HFs and motivated health workers encourage people to access services as shown by increase in curative care and ANC rates Despite the challenges of continuing conflict in Jonglei state PBC does show some improvement in services Due to the contextual challenges the health facilities cannot be given funds and expected to procure essential drugs and commodities on their own. Ongoing training is essential for refreshing and building capacity of continuing staff but also due to high turnover of personnel. It is difficult to isolate and lift up the impact of PBF as a system and the fact that for many this is the only payment they receive on a regular basis
  16. 16. Thank You