PBF CONFERENCE
14TH -17TH FEBRUARY 2011
BUJUMBURA, BURUNDI
DESIGNING OF Sierra Leone simple
performance based financing
Scheme (PBF)
Presented
by
Michael m. Amara
(MoHS – Principal health economist)
Outline of the presentation
1.
Sierra Leone Simple PBF Scheme
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•
2.
Implementation Arrangements
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3.
Institutional Structure
Key Roles and Responsibilities.
Reporting and verification procedures
Implementation Process
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4.
Rationale for PBF in Sierra Leone
Objectives of Simple PBF Scheme
Outline of Simple PBF Scheme
Simple PBF Interventions
Simple PBF Prices 2011
Achievements
What Next?
Conclusion
Rationale for PBF in Sierra Leone
High mortality and morbidity especially among
young children and mothers
Financial barriers preventing mothers and
children from accessing health care are being
tackled through the Free Health Care policy
We also need to improve the availability of goodquality health services for them to access
PBF can help us achieve this!
Objectives of Simple PBF Scheme
General objective:
 To change the behaviour of health providers at
facility level for them to deliver more quality services
and to increase their productivity in the health
sector.
Specific objectives:
 To increase service utilization at primary health care
facility.
 To improve quality of service delivery at primary
health care facility
Outline of Simple PBF Scheme
 Start in April 2011, funding available till October 2013
 PHUs receive PBF funds every quarter based on
delivery of six key Reproductive and Child Health
interventions
 PBF funds are divided between incentives for staff and
investment or operational costs for the facility
 DHMT and Local Council supervise and verify service
delivery and use of the PBF funds
 Ministry of Health and Sanitation has oversight over
entire scheme
Simple PBF Interventions
The Simple PBF Scheme is based on six key RCH interventions:
• Family planning (BPEHS 7.2)
• Antenatal care of pregnant women (BPEHS 7.1.1.)
• Safe childbirth deliveries (BPEHS 7.1.2)
• Postnatal care of mothers and babies(BPEHS 7.1.4)
• Routine immunisations for children under one (BPEHS 7.6)
• Outpatient consultations for children under five (BPEHS
7.7)
Simple PBF Interventions (cont)
Why were these six interventions chosen?
• Part of the Basic Package of Essential Health Services
• Complements Free Health Care policy: all six
interventions are aimed at the FHC target groups
• The most effective interventions for reducing child
mortality  help Sierra Leone achieve MGD 4
• The most effective interventions for reducing maternal
mortality  help Sierra Leone achieve MGD 5
SIMPLE PBF PRICES for 2011
PBF Indicator
PBF Price (US$)
N1 = Number of new acceptors of modern family planning methods.
2.4
N2 = Number of pregnant women completing series of four antenatal
consultations.
1.4
N3 = Number of pregnant women in labour attended by a health
professional, at the facility.
2.4
N4 = Number of women completing series of three postnatal
consultations
1.4
N5 = Number of children aged less than 12 months completing
national EPI immunization course.
1.4
N6 = Number of outpatient visits of children under five
0.1
FUND HOLDER
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SERVICE PROVIDER
MoFED: Local
Govt. Finance
Department
REGULATOR
Ministry of Health
and Sanitation
INDEPENDENT VALIDATOR
Independent
Validation Agency
Contract
PBF Supervision/
Verification
Agreement
District Health
Management
Team
Local Council
Independent
Validation Agency
Tripartite PBF
Agreement
Peripheral Health
Unit or Clinic
Institutional Structure and Agreements
Health
Management
Committee
Key Roles and Responsibilities

The Ministry of Health and Sanitation is the national regulator of
Simple PBF Scheme:



The Ministry of Finance and Economic Development (LGFD) is the
national fundholder for the Simple PBF Scheme


Design of the scheme in collaboration with stakeholders: setting the rules,
indicators, prices.
Monitoring and evaluation of implementation
Disburses PBF funds to local councils on receipt of verified PBF reports
The Local Council (LC) is the local fundholder and purchaser of health
services for the Simple PBF Scheme
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

Contracts PHUs to provide health services, jointly with the DHMT
Disburses PBF funds to PHUs
Supervision of PHUs jointly with DHMT (focus on financial management
and data verification)
Key Roles and Responsibilities (cont)

The District Health Management Team (DHMT) is the local regulator of
the Simple PBF Scheme
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
The Peripheral Health Unit (PHU) is the service provider for the Simple
PBF Scheme
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

Leads on implementation and training at district level
Supervision of PHUs jointly with LC (focus on clinical supervision and data
verification)
Provides primary healthcare services to the population, including the six
key PBF interventions
Receives and spends PBF funds
Reports regularly to DHMT and Local council on service delivery and use of
PBF funds
A contracted agency (NGO or CSO) working in conjunction with local
health management committees will provide independent validation
of the PBF performance reports
Implementation Process: Achievements
 Technical Team formed to design the Simple PBF Scheme and draft the
Operational Manual
 Consultative meetings held with World Bank staff and
 Technical support funded by World Bank
 First draft of the operational manual circulated for comments and inputs
 Consultative meeting with all stakeholders: MoHS directors and managers,
DMOs, district M&E officers, Local Council chairs, health sector development
and implementing partners
 Revised draft of the operational manual produced and circulated for
further comments and inputs
 Training Manual for Training of Trainers produced
 Training of Trainers (TOT) conducted in Bo, 11th – 21st January 2010 (DHMT
and LC M&Es, District Health Sisters)
Implementation Process: What Next?
Finalise the Operational Manual for approval
by MoHS and submission to the World Bank
Districts to organise Cascade training for PHU
In-Charges and other key personnel
(February/March 2011)
Roll-out of revised data reporting tools
PBF implementation starts on 1st April 2011
PBF Reporting, Supervision and Verification Process
PHU submits DHIS
forms to DHMT by 5th
of every month
PHU DHIS
forms
Peripheral Health Unit or
Clinic
Joint Supervision and Verification
checklist completed and data
entered by quarter end
Supervision and
Verification
Checklist
Internal
Verification
Team
District Health
Management Team
PBF Report
DHMT completes data entry
of all forms and submits DHIS
data to MoHS by 15th of every
month
DHMT submits PBF report to LC
by 18th of month after quarter
end, cc MoHS
DHIS
Data
____
Local Council
Certified PBF
Report
Ministry of Health and
Sanitation
MoHS approves reports from LCs, compiles and
forwards to LGFD by 5th of second month after
quarter end
LC certifies PBF Report and submits
to MoHS by 30th of month after
quarter end
Approved and
Compiled PBF
Report
MoFED: Local Govt.
Finance Department
PBF Payment Disbursement Process
Approved and
Compiled PBF
Report
LGFD receives PBF Report and by
5th and disburses PBF payments
to LCs by 10th of second month
after quarter end
MoFED: Local Govt. Finance
Department
Report on
disburse-ment
to LCs
Ministry of Health and
Sanitation
LGFD copies disbursement
information to MoHS
PBF Payment for PHUs and
Internal Verification Team
____
LC copies disburse-ment
information to DHMT
LC disburses PBF payments to
PHU and IVT accounts by 15th of
second month after quarter end
PBF Payment for
PHU
____
Peripheral Health Unit or
Clinic
Report on
disburse-ment to
PHUs
Local Council
PBF Payment for IVT
____
Internal
Verification
Team
District Health Management
Team
PBF Financial Record Keeping and Reporting Process
Peripheral Health
Unit or Clinic
PHU submits PBF
PHU PBF
financial report to
Financial
DHMT by 5th of
Report
month after quarter
end
District Health
Management
Team
Aggregated
PBF
Financial
Report
Internal
Verificatio
n Team
IVT submits PBF
financial report to
DHMT by 5th of
month after quarter
end
VT PBF
Financial
Report
I
Aggregated
PBF Financial
Report
DHMT aggregates PHU financial
reports and submits to LC by 15th
of month after quarter end,
copying MoHS
Local Council
Approved PBF
Financial Report
LGFD approves financial reports from
LCs, compiles and forwards to MoHS
by 10th of second month after quarter
end
Ministry of Health
and Sanitation
Compiled PBF
Financial
Reports
LC approves
aggregated financial
report and submits
to LGFD by end of
month after quarter
end
MoFED: Local
Govt. Finance
Department
Consolidated
Interim
Financial
Report
LGFD submits
consolidated
Interim (unaudited) Financial
Report to WB – IDA
by 45 days after
Conclusion
The PBF system will not replace the existing
structure of healthcare services, but will
complement them and increase the health
workers’ productivity.
Thank you