Experience of peer

visit of PBF program

in Chad Cameroon Presentation

ToRs of the Peer Visit

To document critically and constructively the implementation and immediate outcomes of

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

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 ;

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

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

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. ..

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.

Suggestions to Chad Program

• Train health center staff training and regulators to use the index tools for managing the totality of all their financial resources:

• Respect the autonomy of management of centers and the Separation of Functions of different actors;

• Amend contracts to align the content with principles of PBF Best practice;

• Harmonize the criteria for validation of services declared and supervise the verificators

• Take into account the results of the community assessment in the development of action plans and remuneration of health centers

• We must start to identify the structure that must play the role of PPA after the departure of Aedes.

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