CHAZ PBF Experience PBF Conference for the Multi-country network held in Burundi 14 th – 17 th February 2011 Churches Health Association of Zambia Box 34511, Ben Bella Road, Lusaka, Zambia Phone /237328, Fax: , Cell: / Website

He sent them to Preach the Kingdom of God and Heal the sick ” Luke 9:2 2

CHAZ Background Information “He sent them to preach the Kingdom of God and heal the sick” Luke 9:2 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. Others Recipient of the Joint Financial Arrangement (JFA) One of the major PBF implementers in the country

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. 4

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 districts 4. Harmonised of the PBF approach between CHAZ and MoH 5. Local capacity built in training on PBF 5

History of P4Pin Zambia “He sent them to preach the Kingdom of God and heal the sick” Luke 9:2 In 3 Dioceses (Mansa, Mpika and Chipata) 6 hospitals, 7 health centres Mansa Diocese: (started ),St. Paul’s Hospital, Lubwe Hospital, Kasaba Hospital, Health desk Chipata Diocese Minga Hospital (started ), Lumezi Hospital (started ), Kanyanga HC (started ), Muzeyi HC (started ), Health Desk (started ) Mpika Diocese: Our Ladies Hospital (Chilonga) (started ), Chalabesa HC, (started ), Mulanga HC (started )Ilondola HC (started ), Mulilansolo HC (started ),Health Desk (started ) 6

P4P Evaluation “He sent them to preach the Kingdom of God and heal the sick” Luke 9:2 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 interventions Use of a more contextualized approach in the design process 7

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 9

CHAZ INVOLVEMENT Following the recommendation for CHAZ involvement in P4P 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, DHMT) Shared PBF strategies with the TWG-MoH TWG accepted the CHAZ PBF strategy Selected districts shared with MoH 10

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 project Workload in terms of staff/contact ratio: preferably average (neither high nor low) Disease burden: child malnutrition (% underweight), pneumonia, % institutional deliveries Catchment population served by church health institutions: ideally not more than 100,

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, HAC 14

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Verification procedure Quality 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 index) 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 Invoices Are consolidated by the PBF district steering committee 16

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 organizations Shared experiences with stakeholders in the country 17

Selected Indicators/ costs 18

Quarter 3 (2010) results 19

“He sent them to preach the Kingdom of God and heal the sick” Luke 9:2 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 pre- financing schemes Gradual intergration of PBF into the routine CHAZ program management 20

Thank you for your attention 21