CHAZ PBF Experience
PBF Conference for the Multi-country
network held in Burundi
14th – 17th February 2011
Churches Health Association of Zambia
Box 34511, Ben Bella Road, Lusaka, Zambia
Phone 260 1 229702/237328, Fax: 260 1 223297, Cell: 0979568292/0977790499
Email: [email protected]
He sent them to Preach the Kingdom of God and Heal the sick ” Luke 9:2
CHAZ Background Information
Formation & Membership
• Formed in 1970 ( Catholic and Protestant Medical Committees)
• Interdenominational (Catholic and Protestant) umbrella organisation for
146 CHIS in 9 Provinces and 56 Districts (out of 72):
36 Hospitals & 81 RHCs & 9 Training Schools
29 CBOs: 20 Community Based Programmes & 9 Catholic Dioceses
Health Services Coverage
• CHAZ is the second largest provider of health services in Zambia.
• MoU with the MoH: 75% Grant, 90% Staff , 90% Essential Drugs
Principal Recipient Status
• PR for the Global Fund Mechanism in Zambia for all the 3 disease
components: HIV/AIDS (including ART), Malaria & TB.
• Recipient of the Joint Financial Arrangement (JFA)
• One of the major PBF implementers in the country
“He sent them to preach the Kingdom of God and heal the sick” Luke 9:2
Project objectives
Overall objective
The overall purpose of the PBF project is to safeguard health sector performance and
contribute to the achievement of a better health status of the Zambian population.
Specific Objectives
• To build capacity among church health and government institutions and the CHAZ
secretariat for the gradual introduction of performance based financing
• To document experiences, conduct action research and share lessons learnt on PBF
and its various dimensions
• To promote effective community participation in relation to PBF
• To actively take part in the international network of exchange (community of
practice) on PBF that is unfolding.
Project Expected Outcomes
1. The voice of the client is strengthened.
2. Improved CHAZ capacity to expand and promote PBF independently
3. Actively piloted PBF strategy in government and mission facilities in two
4. Harmonised of the PBF approach between CHAZ and MoH
5. Local capacity built in training on PBF
History of P4Pin Zambia
In 3 Dioceses (Mansa, Mpika and Chipata) 6 hospitals, 7 health centres
Mansa Diocese: (started 1-1-2007),St. Paul’s Hospital, Lubwe
Hospital, Kasaba Hospital, Health desk
Chipata Diocese
Minga Hospital (started 1-1-2007), Lumezi Hospital
(started 1-1-2008),
Kanyanga HC (started 1-1-2008), Muzeyi
HC (started 1-1-2008), Health Desk (started 1-1-2008)
Mpika Diocese:
Our Ladies Hospital (Chilonga) (started 1-1-2007), Chalabesa HC,
(started 1-7-2008), Mulanga HC (started 1-7-2008)Ilondola HC
(started 1-7-2008), Mulilansolo HC (started 1-1-2009),Health
Desk (started 1-7-2008)
“He sent them to preach the Kingdom of God and heal the sick” Luke 9:2
P4P Evaluation
•Evaluation was done in the 3 dioceses
•Revealed both positive and negative outcomes
•Recommended the involvement of a local
stakeholder (CHAZ) in project management
•Extensive involvement of the stakeholders in health
•Identified a need for a pilot on proper PBF
•Use of a more contextualized approach in the
design process
“He sent them to preach the Kingdom of God and heal the sick” Luke 9:2
The CHAZ PBF Pilot Project
2 districts selected for PBF piloting
Selection based on a set criteria
EU Funded PBF is a multi country project,
Pilot implemented in 3 years from Jan 2010 – Dec
Implementation strategies
Seven core strategies will be employed to implement the project:
• Actual (co-)financing of (health) services based on past
performance, through the conclusion of service agreements for
church health institutions
• Capacity building
• Exchange visits and peer review
• Action research
• Site visits for monitoring purposes
• Consultation at national, district and community level
• Documentation and dissemination
• Following the recommendation for CHAZ involvement in
• In July 2009 CHAZ studied the P4P situation and
sensitized the stakeholders on PBF development
• Advocacy for PBF to all stakeholders
• Developed institutional framework (WB, UNZA, MoH,
• Shared PBF strategies with the TWG-MoH
• TWG accepted the CHAZ PBF strategy
• Selected districts shared with MoH
Pilot District Selection Criteria
Rural district
Church presence (in view of Govt/FBO collaboration), in particular:
the number of hospitals and h/centres and share of churches’ catchment
population as a % of total district population
P4P history (with Cordaid)
Not an RBF district (intervention or control district) in the WB supported
Workload in terms of staff/contact ratio: preferably average (neither high nor
Disease burden: child malnutrition (% underweight), pneumonia, %
institutional deliveries
Catchment population served by church health institutions: ideally not more
than 100,000.
District Selection
Selection Cont’n
CHAZ /PBF Implementation Structure
The project emphasizes on split of responsibility
• Fundholder Agency - CHAZ
• Regulator – quality standards - DHMT
• Local Purchasing Agency – responsible for contracting ZSIC
• Local Verifier Organisation– client satisfaction surveys
• Health facilities – DOPE and DAPP
• Community organizations/committees – NHC, HCC,
Verification procedure
Done by local quality experts with performance contracts
Follow agreed upon quality standards
Give a score expressed in percentage
Quality will determine the absolute score (rewards =Quality*quantity*performance
Quantity/data verification
Conducted by the LPA - ZSIC
Produces provisional invoices based on data results
Client Tracer surveys
• Conducted by a locally based NGO – contracted
Results inform the next quarter business plans for the facility
In future, survey results will determine
Are consolidated by the PBF district steering committee
Where are we?
Project design finalized
Actual implementation commenced in July, 2010
Baseline survey conducted
Desk review on existing levels of performance contracting in CHAZ
Performance verification for quarter three (2010) conducted
Project implementation manual
Capacity building activities for policy makers and implementers
Collaboration with other stakeholders - Trainers, LPA, Local verifier
• Shared experiences with stakeholders in the country
Selected Indicators/ costs
Quarter 3 (2010) results
Sustainability plan for the CHAZ PBF scheme:
•Involvement of other critical stakeholders (Local purchaser,
Community organisations, MoH, UNZA)
•Member of the TWG-HCF and the PBF national steering committee
•Transparency about PBF-funding / Inequity
• Intergrated planning and reporting for PBF
• Community involvement – possible gradual intriduction of prefinancing schemes
•Gradual intergration of PBF into the routine CHAZ program
“He sent them to preach the Kingdom of God and heal the sick” Luke 9:2
Thank you for your attention

A PBF experience in Zambia - Performance Based Financing