1. Ministry of Health & Social Welfare Experiences in PBF Program in Liberia
Community of Practice Conference March 18-19, 2011 Saly (Senegal)
By Benedict C. Harris & Dominic Togba

2. Outline Country context PBF Policy Development Design & Implementation
Description of Experiences (actors, intervention sites)
Areas of concern
Lessons Learnt & Next Steps

3. High Maternal mortality: 994/100,000
Country Context
High Maternal mortality: 994/100,000
High Child mortality: 110/1000 (LDHS)
High poverty level (64% below poverty line)
Political stability and economic recovery and growth:
GDP: 2008/09 remains constant at around 10%
Liberia is 7th fastest growing economy in 2009 out of 44 countries

4. MOHSW Vision & Mission Vision: Mission:
2011: is moving away from the post-conflict mentality to a vision of “Healthy population with social protection for all”
Mission:
“reform and manage the sector to effectively and efficiently deliver comprehensive, quality health and social welfare services that are equitable, accessible and sustainable for all people in Liberia”

5. PBF Policy Increase equitable access health services
Improve the quality of service provision
Strengthen national and county support systems to restore government management of government health facilities

6. PBF Implementation Approaches:
Piloted a mixture of approaches :
Contracting in- one level of government contracts with another
Contracting out- a partner is contracted with complete authority over all resources (human, material and financial) to provide health services

7. PBF Design & Implementation
Contracting In:
Bomi County Health Team
Provision of BPHS in 19 health facilities
Bomi subcontracted with African Humanitarian Aid (AHA) to support provision of BPHS in 6 facilities
Amount: USD 2.1 Million (MoHSW Pool Fund*)
Period: Nov 2009-June 2011
Contracting Out:
5 NGOs (Merlin, AHA, International Rescue Committee, Save-the Children-UK and Pentecostal Mission Unlimited (PMU))
Provision of BPHS in 100 facilities
5 Counties: Maryland, Grand Gedeh, Nimba, Montserrado and Lofa
Amount: USD 18.5 Million (MoHSW Pool Fund)
Period: November 2009-June 2011
*MOHSW Pooled Fund established in April 2010 (with an initial 2-year timeframe) backed with DFID, Irish Aid and EU financial support

8. PBF contracts by type of health facility
Contracting-out
(NGOs )
Contracting-in
(BOMI CHT )
TOTAL
Clinic 87 19
106
Health Center 8
Hospital 5 1 6
100 20
120

9. PBF Budget by County PBF BUDGET (US$) COUNTY ORGANIZATION AMOUNT Bomi
CHT
2,118,489
Gbarpolu
AHA
2,326,021
Grand Gedeh
Merlin
4,384,330
Lofa
PMU
2,111,701
Maryland
4,335,965
Montserrado / Bong
SCUK
1,268,632
Nimba
IRC
1,520,661
Rivercess
2,628,488
TOTAL
20,694,287

10. PBF Key Accomplishments
PBF Structure:
Establishment of PBF Steering Committee
Set up a PBF sub-unit at MoHSW
Development of policy document and PBF contracts :
National PBF indicators selected
PBF targets selected (in progress)
PBF payment plan and budget developed
PBF M&E and data verification plan developed
Capacity building :
Study tour in Rwanda
Training of trainers (national and Bomi CHT)
NB: Strong partnership with RBHS/MSH

11. Constraints Implementation constraints: Financial sustainability:
Lack of operation/implementation manual and tools providing guidelines for implementation
M&E and Data verification mechanism not yet fully operational
Delay in payment of the performance bonus to providers (leading to lack of motivation)
Few people trained in PBF implementation
Financial sustainability:
Pool fund : funds available up to June 2011

12. Lessons Learned Retention of HRH in Bomi Minimized HRH staff turnout
Need to have a complete unit responsible for PBF and fully staffed /capacitated
Avoid grey areas: Be able to clearly define roles and responsibilities of stakeholders (providers, contracting agency, etc)
Make transactions more efficient; providers performance bonus needs to be paid more frequently and timely

13. Next Steps & Dates Key activities* (2011):
Assessment of the PBF institutional and implementation arrangements
Development of the PBF operational manual
development of a detailed road map and costing/budget for long term sustainability
Conduct training of key implementers:
TOT (PBF Technical Committee, PBF Unit, NGOs implementing PBF)
Training of CHTs: PBF Task Force, Secretariat and validation Teams
Training of Health staff (community health dev, committee; staff at health centers/clinics)
*: with technical support from RBHS and World Bank

14. Next Steps & Dates
PBF scale-up plan:
Phase 1 (2011): Improve and consolidate existing PBF programs with NGOs and Bomi CHT
Phase 2 ( ): Extend PBF program to CHTs in 5 counties (where NGOs already operate including RBHS); Introduce PBF program at the hospital level
Phase 3 ( ): Extend PBF to all counties and shift NGOs roles to support CHT and health facilities; introduce Community PBF program

15. Thank You for Your Attention