CHAZ
Public Private Partnership in PBF
Church State Collaboration)
Presentation to the PBF Multi-Country Conference In
Bujumbura Burundi
February, 2011
by
Mrs Rosemary Kabwe (CHAZ)
Dr Welani Chilengwe (Maj) (MoH)
Clement Chibanga (CHAZ)
www.chazhealth.zm.org
The Zambia: Size and location
“He sent them to preach the Kingdom of God and heal the sick” Luke 9:2
The Zambian Country Situation
“He sent them to preach the Kingdom of God and heal the sick” Luke 9:2
The Zambian Health Sector
Zambia has both the public and private providers of health services mostly
categorised by ownership of the infrastructure at the facilities
• Public Sector – These are government owned hospitals, clinics and health
post providing health services
• Private Sector
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The mission Health facilities
• Employer owned clinics including mine facilities
• Private for-profit clinics and hospitals,
• Pharmacies,
• Shops
• Traditional providers.
The Mission facility providers form the largest private providers of health care
services in Zambia and are represented by the Churches Health Association
of Zambia (CHAZ)
“He sent them to preach the Kingdom of God and heal the sick” Luke 9:2
Organisation health services in Zambia
Public Health Care is divided into the following sub-categories
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Health post
Rural Health
Urban Health centres
First level hospitals – district hospitals
Second level hospitals – general hospitals/provincial hospitals
Third level hospitals - Tertiary Hospitals
CHAZ has Hospital Rural health ;provides service in rural health centre, first
level and second level categories.
“He sent them to preach the Kingdom of God and heal the sick” Luke 9:2
CHAZ partnership with government in PBF
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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
• 29 CBOs: 20 Community Based Programmes &
9 Catholic Dioceses
“He sent them to preach the Kingdom of God and heal the sick” Luke 9:2
Church - Government Partnership
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CHAZ has an MoU with the MoH:
75% Grant running cost90% Staff
90% essential Drugs
The MoU is guided and harnessed by the
governments commitment to the provision of free
health care services to all Zambians
• CHAZ operates within the framework and
guidelines of the National Health Strategic Plan
“He sent them to preach the Kingdom of God and heal the sick” Luke 9:2
CHAZ links to the Ministry of Health
CHAZ is represented at a number of Sector Wide
Approach (SWAp) fora to represent the interests of
Civil Society Organizations in health through:
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Annual Consultative meetings with the donors,
Policy Consultative meeting,
Sector Advisory Groups (SAG) and
Technical Working Groups such as:
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HIV and AIDS,
TB, Malaria,
Planning and Policy development,
Human Resources management and
Monitoring and Evaluation.
Health Care Financing
Drugs and pharmaceutical products and supplies
CHAZ is also actively involved in the Joint Annual Reviews
(JAR) process
“He sent them to preach the Kingdom of God and heal the sick” Luke 9:2
CHAZ partnership with government in PBF
PBF in Zambia is governed under the Health Care Financing Technical
Working Group at MoH which is the highest policy making body for
financing:
1. CHAZ holds an advisory role in the TWG-HCF for all PBF initiatives
2. CHAZ is part of the team designing the PBF institutional framework for Zambia,
enshrining PBF in both the Sixth National Development Plan (SNDP) and the
National Health Strategic Plan (NHSP 2011 – 2015)
3. MoH and World bank is piloting PBF in one district and a role out plan to nine
districts in all the nine provinces
4. CHAZ is a member of the PBF steering committee which oversees all output
based financing mechanisms and coordinates its implementation
5. The selected districts for PBF implementation were based on a consensual
criteria with all stakeholders in the TWG-HCF
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National PBF Approaches
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MoH is implementing PBF in one district with a plan to roll-out to nine
districts
CHAZ is the other major PBF implementer in Zambia with a pilot in
two districts
The two PBF interventions though similar are variant in 3 respects:
emphasis on quality, split of responsibility and community voice
PBF activities in particular are managed through the national PBF
steering committee which is part of the TWG_HCF
CHAZ is part of both the TWG-HCF and the PBF steering committee
- took part in the design of the RBF project model
“He sent them to preach the Kingdom of God and heal the sick” Luke 9:2
PBF project Design process
• CHAZ took part is the design process of the PBF roll out project plan
where the PBF model was finalized
• CHAZ project design influenced the PBF focus to incorporate:
community voice strengthening (community perspective ), split of
responsibility, and quality assessment
• The two projects shared notes and experiences on the various project
aspects to identify the best PBF intervention/approach
• MoH accessing the WB and CHAZ project interventions to inform the
future PBF roll plan
• CHAZ capacity building plans also considers those from the WB funded
participants for project synergy
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“He sent them to preach the Kingdom of God and heal the sick” Luke 9:2
Challenges of the CHAZ PBF scheme compared with RBF
• No proper control districts to compare results for confounding factors
• Insufficient funds to procure needed equipment
• Delay in regulatory decision making processes such as opening of
bank accounts by government owned health facilities
• inadequate staffing in PBF facilities
• Inadequate relevant training in EmoANC
• Inadequate funding by GRZ to some facilities implementing PBF
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“He sent them to preach the Kingdom of God and heal the sick” Luke 9:2
Thank you for
your attention
God bless
“He sent them to preach the Kingdom of God and heal the sick” Luke 9:2
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CHAZ has an MoU with the MoH - Performance Based Financing