CHAZ Public Private Partnership in PBF 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)

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 “He sent them to preach the Kingdom of God and heal the sick” Luke 9:2 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. 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)

Organisation health services in Zambia “He sent them to preach the Kingdom of God and heal the sick” Luke 9:2 Public Health Care is divided into the following sub-categories 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.

6 CHAZ partnership with government in PBF

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 29 CBOs: 20 Community Based Programmes & 9 Catholic Dioceses

Church - Government Partnership “He sent them to preach the Kingdom of God and heal the sick” Luke 9:2 CHAZ has an MoU with the MoH: 75% Grant running cost- 90% 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

CHAZ links to the Ministry of Health “He sent them to preach the Kingdom of God and heal the sick” Luke 9:2 CHAZ is represented at a number of Sector Wide Approach (SWAp) fora to represent the interests of Civil Society Organizations in health through: Annual Consultative meetings with the donors, Policy Consultative meeting, Sector Advisory Groups (SAG) and Technical Working Groups such as: –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

10 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 CHAZ partnership with government in PBF CHAZ partnership with government in PBF

National PBF Approaches “He sent them to preach the Kingdom of God and heal the sick” Luke 9:2 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

PBF project Design process “He sent them to preach the Kingdom of God and heal the sick” Luke 9:2 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

Challenges of the CHAZ PBF scheme compared with RBF “He sent them to preach the Kingdom of God and heal the sick” Luke 9:2 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

“He sent them to preach the Kingdom of God and heal the sick” Luke 9:2 Thank you for your attention God bless