1. Home Grown Incentives in Katete District Harrison Mkandawire District Director of Health Katete District

3. Katete at a glance  Population: 233,582 (CSO-2000)  Health centres: 26  One general hospital:1  Trained staff: 86%  Number of CBHCP: 2,462  District grant: K406,341.932  MBB District

4. Why we Introduced Incentives Health Care workers paid salaries that are not linked to output or outcome measure High maternal mortality ratio High infant mortality rate More deliveries taking place at home Focus was on input or processes High CBHCP turn over

5. Anchorage Results based planning Results based management Participatory Planning District Health system strengthening

6. PPP CIDRZ CHAMP LWF CARE INTERNATION

7. The home grown incentive mechanisms: rewarding institutions for actual not promised performance linking funding to the quantity of outputs or the quality of outcomes rather than inputs using performance indicators that reflect public policy objectives rather than institutional needs designing incentives for institutional improvement, not just maintaining status quo

8. Why Incentives for Health Workers Link Incentives to performance Hold them accountable for the results Change their mindset Accelerate the attainment of health related MDGs

9. Indicators to be attained Institutional deliveries Fully immunised children ITN utilisation IPT Coverage Pit latrine coverage Contraceptive uptake PMTCT

10. Incentives for TBAs K100,000 ( Thirty Dollars ) Chitenje material Bicycles

11. Incentives for clients  Mama kit- those who deliver in the facility  Baby Kit for post-natal- 6 days, 6 wks  Food for Ante-natal clients and Under five clients  Food for clients who attend outreach sessions

12. Financial incentives for Health workers Floating Trophy K1,000,000 for the best performing health centre K800,000 for the facility for achieving the target

13. Source of Funds 10% community allocation from the district grant 4% replacement of the lost user fees Child health and Maternal Health allocations Community Development Funds

14. Reorientation of CBHCPs Galvanise efforts towards MNCH Retrained CBHC Use of RDTs at Community level Use of Coartem at Community level Use of Amoxy at Community level

15. Other Innovations Bicycle Ambulances Community HFRs Transport for the Dischargees from the hospital and the deceased Solar panels for staff houses All centres have motorbikes All centres have HFRs Detached delivery rooms Display of imprest allocation to health centres 100% disbursement of imprest to health centres

16. Innovations cont…. Motor bikes for all health centres Imprest schedules distributed to Health centres, Health centre chairpersons councillors and Members of parliament K300,000 local retention allowance Collection of school children for the members of staff in hard to reach areas

17. Management benefits Management latitude Innovativeness Development of teams cohesion Team accountability

19. Challenge Increased attendance in health centres

20. Sustainability Use of the local resources PPP- Dunavant Cotton Company Participatory planning

21. Conclusion Need to increase the coverage of selected MNCH services to reach the MDG Ineffective incentives faced by both providers and households hinder achievements of health outcomes.

22. THANK YOU FOR YOUR ATTENTION.