February 2010 Petra Vergeer, Health Specialist RBF Team, World Bank At a glance… Verification of performance linked to financial incentives by Joe Naimoli & Petra Vergeer

Outputs and Outcomes Capacity Building Autonomy Accountability Incl. Community Voice Transparency Regular Incentivizing of Performance Results PBF: Simplified concept

Relatively new function Donors and government acutely sensitive to potential for “over-payments” for inflated service reporting Avoid appearance of, or actual conflict of interest: provider has incentive to over report; separate actor must verify reporting Verification: Essential element of implementation Not to be confused with M&E

Multiple actors/functions- Conflict of interest?

Process for ensuring the consistency of routine reporting on the volume and/or quality of purchased services provided (recount of data) Process for confirming that patients reported to have received purchased services received them (patient follow-up) Direct observation of conditions of service delivery and actual care Schemes often include multiple approaches Verification- different methods used

WB: Afghanistan, Argentina, Cambodia, Rwanda NGO experiences: Burundi, Haiti Industrialized country: USA (Medicare) GPOBA GAVI Global Fund Snapshots of existing verification experiences:

RWANDA Verification of consistency of reported results with registers, etc Verification of services received Intern al verific ation Quantity of MNCH & HIV services (FFS) Verification against registers by local govn ’ t controller (monthly) Field Visits to the community to check if services received (quarterly) Capacity for quality services Check-list of quality performed by district supervisors (quarterly) Exter nal verific ation Quantity of MNCH & HIV services (FFS) Field Visits to the community to check if services received (quarterly)- Sampling established at national level identify 4 out of 30 districts where 25% HFs visited Capacity for quality services Check of quality scores by nat ’ l coordinating body of technicians (semi-annually) Decision to pay Steering committee after internal control. Rectification incentives/Sanctions following external verification

BURUNDI Verification of consistency of reported results with registers, etc Verification of services received Inter nal verifi catio n Quantity of services (FFS) FHA AUditors verify reported data against registers (monthly) Capacity for quality services Measurement by health authorities (district & provincial) of quality components Exter nal verifi catio n Quantity of services (FFS) Visits by FHA-contracted community group to check if patients received services (quarterly) -Sampling patients at HF level Quality of services Measurement of client satisfaction in the community, combined with quality scores at health structures for payment of a quality bonus (quarterly) Decision to pay Fund Holder after internal control. Rectification incentives/Sanctions following external verification

Cambodia Verification of consistency of reported results with registers, etcVerification of services received Inter nal verifi catio n Quantity - various NGOs NGO monitoring of HF reports NGO conducting spot checks of patients drawn from facility registers Quantity & performanc e - various NGOs NGOs verify staff performance Exter nal verifi catio n Indicators of coverage & utilization - NATIONAL / various NGOs Verification of coverage by the MOH central-provincial monitoring team against HIS data (emphasis on denominators) Household surveys and interviews conducted by the MOH central-provincial monitoring team. Sampling- 2 villages in HF catchment area of an operational district Capacity for quality services MOH central-provincial visit HFs and observe quality of care provided and staffing levels Decision to pay Monthly NGO pays and determines incentives to individual HF staff. Quarterly meetings between contracted NGO and MOH Monitoring group providing feedback

HAITI Verification of consistency of reported results with registers, etc Verification of services received Inter nal verifi catio n Phase I - Coverage & service utilization Phase II - utilization of services Assessment management indicators (HMIS correctly) by project team Exter nal verifi catio n Phase I - Coverage & service utilization Baseline and follow up data immunization and ANC +3 coverage each NGO catchment. Exit interviews (& "quality of services" assessment) conducted by independent research firm Phase II - utilization of services Consistency of summary data cross-checked against facility registers by independent firm in coordination with project team Household visits of a client sample performed by the project team and independent firm Decision to pay Phase I- Contracted NGOs received bonus when above pre- determined target (or within one confidence interval). Phase II- discussions with contracted NGOs

AFGHANISTAN Verification of service provision Verification of health service quality Exter nal meas urem ent Basic package of services Direct observation of patient care, health facility visit, patient interviews, & staff interviews conducted by independent 3rd party agent using the balanced scorecard Decision to pay Annually following the external verification

Mechanics not well documented Strong demand for practical information about how to do it Series of knowledge products proposed. Exploratory and descriptive in the early stages; greater synthesis and analysis in later stages Current knowledge: on a learning curve