February 2010

Petra Vergeer, Health Specialist

RBF Team, World Bank

At a glance… Verification of performance linked to financial incentives

by Joe Naimoli & Petra Vergeer

Outputs and Outcomes

Capacity Building

Autonomy

AccountabilityIncl. Community Voice

Transparency

Regular Incentivizing of Performance

Results

PBF: Simplified concept

Relatively new function

Donors and government acutely sensitive to potential for “over-payments” for inflated service reporting

Avoid appearance of, or actual conflict of interest: provider has incentive to over report; separate actor must verify reporting

Verification:Essential element of implementation

Not to be confused with M&E

Multiple actors/functions-Conflict of interest?

Process for ensuring the consistency of routine reporting on the volume and/or quality of purchased services provided (recount of data)

Process for confirming that patients reported to have received purchased services received them (patient follow-up)

Direct observation of conditions of service delivery and actual care

Schemes often include multiple approaches

Verification- different methods used

WB: Afghanistan, Argentina, Cambodia, RwandaNGO experiences: Burundi, HaitiIndustrialized country: USA (Medicare)GPOBAGAVIGlobal Fund

Snapshots of existing verification experiences:

RWANDAVerification of consistency of

reported results with registers, etc

Verification of services received

 

Internal

verification

Quantity of MNCH & HIV services (FFS)

Verification against registers by local govn’t controller (monthly)

Field Visits to the community to check if services received (quarterly)

Capacity for quality services

Check-list of quality performed by district supervisors (quarterly)

External

verification

Quantity of MNCH & HIV services (FFS)

 

Field Visits to the community to check if services received (quarterly)- Sampling established at national level identify 4 out of 30 districts where 25% HFs visited

Capacity for quality services

Check of quality scores by nat’l coordinating body of technicians (semi-annually)

 

  Decision to pay Steering committee after internal control. Rectification incentives/Sanctions following external verification

BURUNDIVerification of consistency

of reported results with registers, etc

Verification of services received

 

Internal

verificatio

n

Quantity of services (FFS)

FHA AUditors verify reported data against registers (monthly)

 

Capacity for quality services

Measurement by health authorities (district & provincial) of quality components

External

verificatio

n

Quantity of services (FFS)

 

Visits by FHA-contracted community group to check if patients received services (quarterly) -Sampling 60-90 patients at HF level

Quality of services  

Measurement of client satisfaction in the community, combined with quality scores at health structures for payment of a quality bonus (quarterly)

Decision to pay Fund Holder after internal control. Rectification incentives/Sanctions following external verification

CambodiaVerification of consistency of

reported results with registers, etc Verification of services received

 

Internal

verificatio

n

Quantity - various NGOs

NGO monitoring of HF reports NGO conducting spot checks of patients drawn from facility registers

Quantity & performance - various NGOs

NGOs verify staff performance

External

verificatio

n

Indicators of coverage & utilization - NATIONAL / various NGOs

Verification of coverage by the MOH central-provincial monitoring team against HIS data (emphasis on denominators)

Household surveys and interviews conducted by the MOH central-provincial monitoring team. Sampling- 2 villages in HF catchment area of an operational district

Capacity for quality services  

MOH central-provincial visit HFs and observe quality of care provided and staffing levels

Decision to payMonthly NGO pays and determines incentives to individual HF staff. Quarterly meetings between contracted NGO and MOH Monitoring group providing feedback

HAITIVerification of consistency of

reported results with registers, etc

Verification of services received

 

Internal

verificatio

n

Phase I - Coverage & service utilization

   

Phase II - utilization of services

 Assessment management indicators (HMIS correctly) by project team

External

verificatio

n

Phase I - Coverage & service utilization

 

Baseline and follow up data immunization and ANC +3 coverage each NGO catchment. Exit interviews (& "quality of services" assessment) conducted by independent research firm

Phase II - utilization of services

Consistency of summary data cross-checked against facility registers by independent firm in coordination with project team

Household visits of a client sample performed by the project team and independent firm

Decision to payPhase I- Contracted NGOs received bonus when above pre-determined target (or within one confidence interval). Phase II- discussions with contracted NGOs

AFGHANISTAN Verification of service provision

Verification of health service quality

 

External

measurement

Basic package of services

Direct observation of patient care, health facility visit, patient interviews, & staff interviews conducted by independent 3rd party agent using the balanced scorecard

Direct observation of patient care, health facility visit, patient interviews, & staff interviews conducted by independent 3rd party agent using the balanced scorecard

   Decision to

pay Annually following the external verification

Mechanics not well documented

Strong demand for practical information about how to do it

Series of knowledge products proposed. Exploratory and descriptive in the early stages; greater synthesis and analysis in later stages

Current knowledge: on a learning curve