The document discusses the monitoring of the impact of results-based financing (RBF) on healthcare quality in Benin, using a comprehensive quality checklist that includes a variety of health activities. It presents quality score improvements over time for primary health centers and hospitals, highlighting specific areas and components of healthcare quality. The next steps involve developing a dedicated RBF website to further track and improve maternal health care quality indicators.

1. BuenosAires
25 March 2014
Using OP data to monitor RBF’s
impact on quality in Benin

2. Comprehensive quality check list
 Quality adjustment (checklist): quality score in %,
with several composite indicators by type of activity
ACTIVITY ASSESSED
PHC % of the score
General activities 11%
Monitoring-Evaluation/HIS 7%
Hygiene, Environment and
Sterilization 8%
Outpatient visit and
Hospitalization 13%
Maternity 9%
Antenatal consultation 6%
Family Planning 4%
Immunization 5%
HIV/AIDS 10%
Tuberculosis & Leprosy 6%
Laboratory 3%
Small surgery 2%
Drug management 8%
Financial management 8%
TOTAL 100%
ACTIVITY ASSESSED
HOSPITAL % of the score
General activities 13%
Management of the patient 6%
Action Plan 1%
Management of the budget,
accounts and assets 15%
Drug management 15%
Outpatient visit/Emergency 16%
Family Planning 2%
Hygiene and sterilization 7%
Laboratory 4%
Hospitalization 3%
Maternity 9%
Surgical ward 8%
Essential drugs 1%
TOTAL 100%

3. Overview of the website http://www.beninfbr.org/
1-Public access to quality scores of each health facility for the last quarters
2-Benchmarking of top quality score

4. For data analysis
 Login access for details on the quality score by quality component,and
option to export Excel files

5. Data analysis
 Using the data to monitor impact of RBF on quality at
different levels:
 By hospital/primary health center;
 By health district;
 By type of quality components;
 Understand which componentsimpact the overall quality
improvement

6. Quality improvements at PHC and
Hospitals
39.30%
48.76%
52.43%
71%
0.00%
10.00%
20.00%
30.00%
40.00%
50.00%
60.00%
70.00%
80.00%
March &
Q2 2012*
Q3 2012 Q4 2012 Q1 2013 Q2 2013 Q3 2013
Quality score
primary health
centers (184)
Qality score
hospitals (6)

7. Evolution of quality score by Heath
District
0
10
20
30
40
50
60
70
Q2 2012
Q3 2012
Q4 2012
Q1 2013
Q2 2013
Q3 2013

8. Quality score for specific quality
components (health centers)
0.00%
10.00%
20.00%
30.00%
40.00%
50.00%
60.00%
70.00%
80.00%
90.00%
100.00%
Q2 2012 Q3 2012 Q4 2012 Q1 2013 Q2 2013 Q3 2013
Quality evolution between Q2 2012 and Q3 2013
Quality score (global)
Laboratory
TB and Leprosis
Minor surgery
Antenatal Care
Immunization
Hygiene, Environnment,
Sterilization
Family Planning
HIV

9. Understand quality improvements for a
health center
42%
33%
37%
3%
38%
58%
77%
59% 59%
89%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Global quality
score
General activities Outpatient
consultation and
hospitalization
Maternity Minor surgery
Q2 2012
Q3 2012
Q4 2012
Q1 2013
Q2 2013
Q3 2013

10. Use of quality OP data
 Health districtsteams,project coordinationunit,and the
Bank team used the data to:
 Increase support for some health districts or health facilities;
 Analyze which quality componentsrequire the greatest effort;
 Best practices: identify the best performing health structures in
order to share these experiences.

11. Next steps for monitoring RBF impact
on quality in Benin
 Development of the Benin RBFWebsite to monitor
specificallythe key quality aspects of maternal health care:
 Availability of essential drugs;
 Availability of essential equipment;
 Quality of antenatal visits (exam and interview);
 Quality of referrals.

12. Quality improvements in words
 «We had the best quality tools,5S, but when other
hospitals copied us,it was the beginning of a
competition! » (hospital manager, 1st rank for quality for
the first quarters.Then other hospitals had better scores with
peer reviewand experience sharing processes);
 «When a client comes,he doesn’t recognize the
center anymore… we have new equipment,it is
clean,the difference is clear » (health worker, CS
Bohicon)

13. Quality improvements in pictures