A presentation from the 2014 Annual Results and Impact Evaluation Workshop for RBF, held in Buenos Aires, Argentina.

1. Experience of peer
visit of PBF program
in Chad
Cameroon Presentation

2. ToRs of the Peer Visit
To document critically and constructively the implementationand immediate outcomesof
the introduction of FBR in the Chadian health system.
1 ) Assess the attendance of health facilities in FBR compared to control ;
2) Evaluate the presence of qualified personnel in health facilities FBR ;
3 ) Compare the results of the external evaluation in the previous assessment of
the PPA ;
4) Take a critical look at the managerial autonomy and how the funds generated
through PBF and other sources ( cost recovery ) are managed ;
5) Appreciate how PBF averall best practices are implemented by the PPA

3. ToRs of the Peer Visit
6) Assess the perspective of users through their representatives (members of
health committees ) in their consideration of the FBR ;
7) Assess the reports from the community based organizations;
8) Check the conformity of the implementation of PBF as compared to: (i) the
planning that had been agreed with the Ministry of Health and the World Bank ,
and (ii) the PBF Manual of procedures ;
9) Assess PBF management tools ( indicators framework, scorecards reports,
organization of health data evaluation tools, etc ....) ;
10) Evaluate the mechanism of capacity building to allow nationals to take over
the management of PBF after the international PPA ;

4. Preparation
• Before departure (at least 2 weeks): The teams exchanged
by e-mail to develop the terms of reference of the mission;
• On arrival Chad (for 2 days): Preparatory Meeting with the
team MSP / national PBF team - Distribution of field teams
(4 teams consisting of an expatriate and 1 national) -
Review of the guidelines for the assessment
• Upon arrival in the regions: Each team shall contact the
Regional Representative, the Governor of the region to
explain the objectives of the mission

5. Preparation (cont’)
• Upon arrival in Districts: Contact with the District Medical
team. Identification of centers to visit (PBF and non-PBF
areas)..
• In health centers: Introduce the objective of the mission to
the staff, visit the structure, review documents (registers,
record reporting, management tools, etc ...)
• Facilities visited: 31 health centers, 11 DH, 1 RR, 12 EDC 4
ECDSR, 2 Sub-PAA (2 Leaders and 7 auditors), PPA
(central).
• At the end: Debriefing at each level before departure from
the area.
• At national level: presentation of general findings and
recommendations

6. Preparation (cont’)
What should the local team and PPA
prepare for the visit:
• Make available previous data (MIS reports, results of
previous assessments by PPA, regulators, and local
associations):
• Documents such as: norms and standard (Staff,
equipment, etc..), project management documents (manual
of procedures, reporting form, contracts, index tools, etc.).
• Logistics: Vehicle, driver, hotel booking, etc. ..

7. Lessons Learned for Cameroon
• We have learned the concept of “Sub-PPA” that allows one
PPA to cover a population of more than 1.6 million spread
over a large area with large distances between the PPA and
regions. Which for us is an economy of scale.
• If the project was to extend in the coastal region, it is not
necessary to create another PPA. We could just create
branches in some health districts.

8. Suggestions to Chad Program
• Train health centerstaff training and regulatorsto use the index
toolsfor managingthe totalityof all their financial resources:
• Respect the autonomyof management of centersand the
Separationof Functions of different actors;
• Amend contracts to align the contentwith principles of PBF Best
practice;
• Harmonize the criteria for validationof servicesdeclared and
supervise the verificators
• Take into account the results of the communityassessmentin
the development of action plans and remunerationof health
centers
• We must start to identify the structure that must play the role of
PPA after the departure of Aedes.

9. Conclusion
• PBF is a reality in Chad. Just after 13 months of
implementation, changes in the attendance of health
centers, the quality of care and staff motivation is palpable
where the pilot is implemented.
• Potential for improvement of this project are enormous. The
implementation of the recommendations above will improve
the implementation of the FBR and its impact on the health
system in Chad
• Teams from Cameroon and CAR have also learned a lot
from the experience of Chad