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Tanzania Presentation


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Presentation held during GEO meeting organized by ETC/Wemos
Content: Brief presentation of a performance based pilot project in five dioceses in Tanzania

Published in: Health & Medicine
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Tanzania Presentation

  1. 1. Lessons learnt P4P Tanzania Frank van de Looij – CORDAID (
  2. 2. Tanzania approach <ul><li>Pilot because </li></ul><ul><ul><li>Positive experiences in Rwanda/Cambodia </li></ul></ul><ul><ul><li>More emphasis on outcome of funding </li></ul></ul><ul><li>5 dioceses </li></ul><ul><li>5 indicators </li></ul><ul><ul><li>IPD, OPD, Deliveries, VCT and drug stock outs </li></ul></ul><ul><li>0,5 USD per capita </li></ul>
  3. 3. Tanzania approach <ul><li>50% fixed and 50% based on performance </li></ul><ul><ul><li>USD42,000 for hospitals (5% -10%) </li></ul></ul><ul><ul><li>USD14,000 for health centres </li></ul></ul><ul><ul><li>USD7,000 for dispensaries (20% - 30%) </li></ul></ul><ul><li>Criteria for spending funds </li></ul><ul><li>Verification </li></ul><ul><li>Funding through diocesan health offices </li></ul>
  4. 4. Project Output OPD Utilization (HC/Disp) target 0,6 visit per capita IPD Utilization (Hospitals) target 40/1000 population
  5. 5. Project Output
  6. 6. Comparison P4P and non P4P Health centres
  7. 7. Lessons learnt <ul><li>Autonomy: </li></ul><ul><ul><li>Most important principle of PBF </li></ul></ul><ul><ul><li>Misunderstanding about meaning </li></ul></ul><ul><ul><li>Reluctance by donor to let go </li></ul></ul><ul><ul><li>Reluctance by partner to take management role </li></ul></ul><ul><ul><li>Hard to combine with non-decentralized health system </li></ul></ul>
  8. 8. Lessons learnt <ul><li>Choice of indicators: </li></ul><ul><ul><li>Keep number limited (but depends on capacity) </li></ul></ul><ul><ul><li>More attention for preventive care </li></ul></ul><ul><ul><li>VCT not a good indicator </li></ul></ul><ul><ul><li>Include quality </li></ul></ul><ul><ul><li>Reduce risk of perverse effects </li></ul></ul>
  9. 9. Lessons learnt <ul><li>There needs to be a direct link between performance and bonus </li></ul><ul><ul><li>Payments in time </li></ul></ul><ul><ul><li>Bonus is seen as entitlement </li></ul></ul><ul><ul><li>Bonus too small </li></ul></ul>
  10. 10. Lessons learnt <ul><li>Participation </li></ul><ul><ul><li>Community </li></ul></ul><ul><ul><li>Facilities (see Rwanda case) </li></ul></ul><ul><ul><li>Other stakeholders </li></ul></ul><ul><ul><li>Local Government </li></ul></ul>
  11. 11. Lessons learnt <ul><li>Introduction needs to be combined with capacity building </li></ul><ul><ul><li>HRM, financial management, general management </li></ul></ul><ul><ul><li>Planning (business plans, CCHP) </li></ul></ul><ul><ul><li>Toolkit for introduction </li></ul></ul><ul><li>DHO/facilities but also local technical assistance </li></ul>
  12. 12. Lessons learnt <ul><li>Absence of local fund holder: </li></ul><ul><ul><li>No context specific solution </li></ul></ul><ul><ul><li>Delay in disbursement </li></ul></ul><ul><ul><li>Little flexibility </li></ul></ul>