1. Results-based Financing for Health in Tanzania
Health Financing Technical Working Group Meeting
28th August 2015
Ministry of Health and Social Welfare

2. Presentation outline RBF definition
Purpose and goals of RBF in tanzania
Institutional set up
Indicators and factors considered in pricing quality indicators
Available financial resources for RBF implementation
Fund flow in RBF implementation
Invoicing and payment
Progress made
Quality results
Timeline and next steps
Sustainability strategy

3. What is RBF for health?
Results-Based Financing (RBF) – Umbrella term applicable to many sectors
RBF for Health – “a cash payment or non-monetary transfer made to a national or subnational government, manager, provider, payer or consumer of health services after predefined results have been attained and verified” (

4. Role of RBF in health RBF in the health sector is needed to:
Help focus attention on outputs and outcomes
Example: the number of women receiving antenatal care or taking children for regular health and nutrition check ups to reduce child mortality rather than inputs or processes (i.e., training, salaries, medicines).
Balance resource allocations to elevate low performing indicators and maintain existing achievements (like immunizations) to accelerate progress toward national health objectives.
Increase use, quality and efficiency of services

5. Why RBF in Tanzania?
There has been slow progress in achieving some health objectives despite a significant increase in inputs
RBF is an innovation which promotes efficiency in health care delivery
It has observed effects in strengthening health systems
It can be harnessed to move along the road of Universal Health Coverage
Efficient use of limited resources for more and quality output
Enhance D by D implementation up to the level of HFs

6. Goals of Tanzania’s RBF
Overall goals
Strengthen the health system
Accelerate Tanzania mainland’s move to UHC
Help focus government and donor attention on outputs and outcomes
Re-orient mindset of health service providers
Immediate goals
Increase utilization of specified services in health facilities
Increase quality of service provision
Incentivise more focused health workers and management teams

7. INSTITUTIONAL SET UP

8. Institutional setup - Roles
RBF Functions
Regulation
To lead the RBF system with strategic planning and policy coordination among the various actors; provide guidelines, norms and standards and overall support and supervision. (MOHSW)
Fund Holding
To hold the funding for RBF and distribute funds to service providers as indicated by the Purchaser (MoF)
Purchasing
To enter into contracts with service providers, purchase and pay for the health care services. (NHIF)
Provision
To provide health care services to the designated population (HF&HMT)
Verification
To confirm the actual provision of health care services (IAG)
Counter verification
Counter verify (CAG)
Facilitator
Facilitating the providers and verifier (PMORALG)

9. Quantity indicators for dispensaries & health Centers
Category
Indicator
Fee
OPD
Number of new Outpatient consultations
TZS 415
Number of TASAF beneficiaries seeking outpatient care
TZS 1,240
ANC
Number of first antenatal visits, with gestation age < 12 weeks
TZS 8,290
Number of pregnant women attending ANC at least 4 times during pregnancy
TZS 6,210
TREATMENT
Number of pregnant mothers receiving Mebendazole for de-worming
TZS 1,244
Number of children receiving Mebendazole for de-worming
TZS 829
ANC; Malaria
Number of pregnant women receiving two doses of intermittent presumptive Therapy of Malaria (IPT2)
PMTCT:HIV/AIDS
Number of HIV positive (infected) pregnant women receiving ARVs
TZS 3,310
Labor/Delivery
Number of institutional deliveries
TZS 20,720
Postnatal Care
Number of mothers receiving Post Natal Services within 3-7 days after delivery
Immunization
Number of children under one year immunized against measles
TZS 1,650
Nutrition
Number of under five receiving Vit. A supplements
TZS 820
Family Planning
Number of new users on modern Family Planning methods
TZS 5,800
HIV/AIDS
Number of clients initiated by health care provider to counsel and Test for HIV (PITC)
TZS 620
Number of HIV exposed infants receiving ARVs
TZS 4,970 TB
Number of TB suspect referred (already screened)*
Community
Number of non-institutional maternal and perinatal deaths reported within 24 hours by TBA or CHW
TZS 4,145
Number of pregnant women escorted for delivery at a health facility by known or registered TBA or CHW
Number of household visits by CHW

10. RBF QUANTITY INDICATORS PRICING FACTORS
The index indicator was OPD and was given 1 as basic Unit of weighing other indicators,
Priority by indicators,
Coverage,
Available funds for incentives.

11. 18 AREAS FOR DIPENSARY QUALITY ASSESSMENT#
SERVICE
WEIGHT 1
Hygiene and sanitation 9 2
Privacy 4 3
Water supply
Waste management 6 5
ANC 13
Labour ward 7
Post-natal care 8
Maternal death audits 10
Perinatal death audits
Family planning 17 11
Immunization 12
Nutrition for under-five children
Pharmacy 22 14
Community 15
Community health fund 16
Facility profile reports (inc. rbf)
Transparency 18
Client Satisfaction 20
TOTAL
174

12. 26 AREAS FOR D.HOSP & COMPREHENSIVE HC Q. ASSESSMENT#
SERVICE
WEIGHT 1
Social Accountability 5 2
Facility Profile Reports (Inc. RBF) 4 3
Medical Records
Privacy
Hygiene and sanitation 7 6
Water supply 11
Labour Ward 14 8
Waste management 9
Obstetric emergencies 35 10
Partogram 18
Complicated deliveries including c/s 12
Post-natal care 13
Kangaroo mother care 15
Family planning 24
Maternal death audits 16
Perinatal death audits 17
Immunization
Sterilization 19
IPD 20
Laboratory 21
TB Services 22
Pharmacy 23
Nutrition for Under-Five Children
Community 25
Community Health Fund 26
Client Satisfaction
TOTAL
274

13. 12 AREAS FOR CHMT ASSESSMENT#
SERVICE
WEIGHT 1
100% of facilities Monthly HMIS reports timely and completely entered into DHIS-2 10 2
Average (mean) number of tracer medicines available in RBF facilities 20 3
Council Progress Reports for all HFs produced submitted to PMORALG and MOHSW on time 5 4
Health Facilities with qualified staff
100% of HFs have received comprehensive supportive supervision visit at least once per quarter 6
CHF enrolment rate increase in the council 7
Compiled quarterly financial report of all HFs enrolled in RBF 8
Planned preventive maintenance conducted quarterly as budgeted in CCHP [For facilities enrolled in RBF] 15 9
Health Facilities Maternal deaths Audit by CHMT
Health Facilities perinatal deaths Audit by CHMT 11
Council Health Service Board [CHSB] quarterly meeting conducted 12
Management of motivation Agreements
TOTAL
125

14. 10 AREAS FOR RHMT ASSESSMENT#
SERVICE
WEIGHT 1
Spearhead the verification process of the RBF in the region 10 2
RBF data management and Quarterly HFs RBF data timely entered in the database 20 3
Participation in R-RBFC quarterly meetings 15 4
Management of motivation Agreements 5
Timely submission of regional quarterly report, 6
Quarterly report assessment results, 7
Regional Management Supportive Supervision for CHMT (RMSS-C) implementation rate 8
Regional Management Supportive Supervision for Regional Referral Hospital Management Team (RMSS-H) implementation rate 9
Comprehensive Hospital Operational Plan (CHOP) quarterly report submission
Human Resource for Health (HRH) Data collection monthly report
TOTAL
110

15. 3 AREAS FOR IAG ASSESSMENT#
SERVICE
WEIGHT 1
 Timely and Completeness of data entry
 50 2
 Timely R-RBF Verification Committee Quarterly meeting
 25 3
Timely transmission of approved quarterly consolidated invoice to the NHIF 25
TOTAL
100

16. ALLOCATION OF BUDGET Total RBF funds US$ 106.16M USAID $46M
POWER OF NUTRITION
$10M
IDA
$30M
GFF
$ 20M
SDC (TA)
$ 161,861

17. Fund flow for RBF system

18. Funds Flow

19. Flow Charts-Invoicing & Payments

20. CURRENT SCOPE OF PILOT & TIMELINE
SHINYANGA-KISHAPU DISTRICT HAS STARTED PILOT:
41 Dispensaries, 4 Health Centres of Kishapu and 1 District Hospital of Kahama are now piloting RBF system since April 2015.
The performance agreements have been signed by the Providers side and Purchaser
Verification of 1st quarter of implementation (April June) 2015 was recently done for the above Health Facilities
The RBF Invoicing and data analysis component is now integrated into the MOHSW DHIS2 by the contracted University of Dar es salaam,
Data entry is concluded and the approval process by the Regional RBF Committee is about to take place.

21. READINESS ASSESSMENT RESULTS BY BRN STAR RATING
NAME OF HF
STARS 1
KAHAMA D. HOSPITAL
2 Stars 2
KISHAPU HEALTH CENTRE 3
BAKWATA
1 Star 4
NDOLELEJI RC 5
BUNAMBIYU HEALTH CENTRE 6
SONGWA HEALTH CENTRE 7
MAGANZO 8
MIPA FB 9
MWAJIDALALA 10
MASUSANTE 11
MIPA 12
BULEKELA 13
BULIMA 14
ITILIMA 15
NYENZE 16
MAGALATA 17
KINAMPANDA 18
NHOBOLA HEALTH CENTRE 19
MWAMANOTA 20
HINDAWASHI 21
MIHAMA AICT 22
SOMAGEDI 23
NEGEZI 24
BUBIKI 25
ITONGOITALE 26
IDUKILO 27
NYASAMBA N
NAME OF HF
STARS 28
LAGANA
1 Star 29
NGOFILA 30
MWAMASHELE 31
MONDO 32
BUSANGWA 33
BELEDI 34
MASANGA 35
SEKEBUGORO 36
LUBAGA 37
KISESA 38
SHAGIHILU 39
BUGANIKA 40
KILOLELI 41
IKONDA A 42
BUPIGI 43
MIGUNGA 44
MWADUI LUHUMBO 45
ISUNGANG’HOLO 46
IGAGA B 47
BADI
0-Star 48
BUBINZA 49
MALWILO 50
NGEME 51
UCHUNGA 52
ILEBELEBE 53
MUGUDA 54
SESEKO

22. Trainings & Orientations Attendance

23. ATTENDANCE BY GENDER

24. KISHAPU QUALITY ASSESSMENT RESULTS 1st Q2015
KAHAMA DH GOT 46.4% AND KISHAPU CHMT GOT 59.1%

25. TIMELINE & NEXT STEP

26. Sustainability of RBF as envisioned by Health Care Financing Strategy
SNHI
Other vertical or parallel programs or funding
Remainder of general revenue budget & HBF
Portion of OC Budget
AIDS Trust Fund
Employer Contribution
Employee Contribution
GOT subsidy for poor and vulnerable
Community Contribution (CHF)
Reimbursement to Facilities Matching Payment to MBP Based on Core Output-Based Payment Systems, Performance (RBF) and Star Rating (BRN)