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Performance Base Financing project in Lesotho in the area of health care

Afrique Subsaharienne
Source du financement
Mois de travail
Date début
Date fin
Description du projet
Description of the intervention

The performance-based financing intervention will support the provision of quality MNH services as well as selected services in the Essential Services Package at community, health centers and hospitals by providing performance based incentives to Village Health Workers (VHWs), health centers, hospitals, and the District Health Management Teams (DHMTs)

In order to strengthen collaboration between the health centers and the VHWs in the respective catchment areas, they will be considered as one unit for payment of incentives. The performance incentives for VHWs will be linked to the overall performance of the respective health centers to which they are mapped. The incentivized services to be delivered by Health Centers (Minimum Package of Activities [MPA]) and hospitals (Complementary Package of Activities [CPA]) have been developed.

There will be performance-based payments to DHMTs to encourage regular supervision activities and oversight by these entities. Additionally there will be performance-based payments to the Hospital to encourage provision of quality of care. Performance-based payments will be adjusted based on comparative isolation of a facility to provide additional financing to hospitals and health center in remote areas and influence distribution of health personnel.  

Main tasks of the PPTA

The Performance Purchasing Technical Agent (PPTA) will be embedded in the PBF unit of the MOH, while retaining administrative and operational autonomy. The technical reporting line for its functions will be the PBF Unit Director. The core functions of the PPTA will be as follows: (a) capacity building for PBF at all levels of the health system and for other sectors as necessary; (b) development of the training curriculum and training for PBF; (c) contract negotiation and contract management; (d) strategic purchasing; (e) ex-ante verification; (f) managing the public front-end and database of the web-enabled application; (g) support the coordination role of the PBF-unit and (h) organizing the ex-post verifications; the counter-verification mechanisms (community client satisfaction surveys and counter-verifications for the quality).

The PPTA's main responsibility is to provide technical and implementation support to the MOH PBF unit and other PBF implementing entities at national and district levels on managing performance-based contracts with health facilities.

The primary focus of the PPTA intervention is to build local capacity in PBF contract management and verification tasks. The PPTA's intervention strategy will center on selecting appropriate local human resources and to build their capacity.

The firm will also verify delivery of the services, extract the consolidated quarterly invoices from the PBF database and submit these to the District PBF Steering Committees for validation, assist health facilities with preparing their PBF business plans, and provide capacity building support to MOH administrative and technical departments and PBF unit on PBF implementation.

The PPTA will work according to the design of the PBF project as has been developed during the preparatory phase and endorsed by the MOH and the World Bank. The PPTA will be placed within the PBF Unit in the MOH and strengthen the PBF Unit to carry out its purchasing role, while ensuring a separation of functions in the data verification to enhance the credibility of the performance assessments.

Moreover, the PPTA will liaise with the relevant MOH units and district level entities implementing the PBF program. The PPTA will have central level personnel but its main focus is at the district level through its PBF-verifiers who will work closely with each district in verifying reported performance, in  organizing ex-post-verification activities, capacity building of district and health facilities for their new roles and in facilitating the district level performance validation processes.  

To ensure accurate reporting and payments, several mechanisms will be put in place for ex-ante and ex-post verification of data reported by health facilities.  

i) Ex-Ante Verification: The quantity of services delivered by the health centers and hospitals will be verified prior to making the performance payments. This verification will be a core task for the PPTA/PBF-unit. Each PBF facility will create a monthly invoice for its agreed services. The DHMT will verify the quality of service delivery using a quantified quality checklist. For hospitals, each quarter, a peer review mechanism will be employed to perform quality verification and provide immediate feedback to the hospital staff regarding their performance. This peer-evaluation mechanism will comprise of personnel from another hospital, the MOH Quality Assurance Unit, a PPTA verifier and a representative from the DHMT (in observer status). Each quarter, a district PBF steering committee and PBF Unit will review performance data. The PBF-unit will perform due diligence on the approved quarterly consolidated district invoices.  A PBF web-enabled application will be developed by the MOH to facilitate invoicing, strategic purchasing, to strengthen data use and performance analysis and to enhance governance.  

ii) Ex-post verification: This will be carried out in two ways. This ex-post verification consists of community client satisfaction surveys and of counter-verifications of samples of quality checklists for health centers and hospitals. The PPTA will contract local civil service organizations to visit homes (or by telephone) of randomly chosen clients (selected from the facility registers) to determine whether they exist, whether they received the services that have been paid for, and their satisfaction with these services. Each quarter, a random selection of health facilities and services will be assessed according to a tested protocol. Based on a tested protocol, a random sample of health centers and hospitals will be subject to a counter-verification of the quality checklists. Additionally, annual health facility surveys will be carried out by the MOH Quality Assurance Unit to verify the Health Facility Quality of Care Score.
Description des services rendus
The PPTA will work closely with the PBF Unit and will be responsible for carrying out the following activities:

4.1 Capacity building and technical advice

1. To provide technical and implementation support to the MOH PBF Unit contributing to institutional strengthening of the PBF unit so that it will be able to manage the MNH PBF project - while ensuring an adequate separation of functions between the regulator, the purchaser and the provider;
2. To provide technical support for the implementation of the PBF project, which has been designed and detailed in the Project Implementation Manual (PIM). The firm is expected to refine a more user-friendly PBF user manual, targeting front-line health workers and district health staff, which has been developed and used during the pre-pilot phase;
3. To propose incremental modifications to the PBF user manual, based on accumulated experience with implementation of the PBF pre-pilot and pilot, through organizing an annual consultative process with key stakeholders;
4. To provide technical assistance related to PBF operational procedures, including training of health workers, health center committees, District Health Management Teams and District Councils, and to refine and implement an appropriate training curriculum, developed during the pre-pilot phase, following international best practice, adult learning techniques and approaches and based on the PBF intervention as detailed in the Project Implementation Manual;
5. To provide technical assistance in the maintenance and continuous development of the PBF database, on drafting the annual reports, and on assisting in advanced data analysis and reporting, including with triangulation with other databases.

4.2 Operational tasks

a. To assist the PBF Unit in signing contracts with the District Councils and District Hospitals for the delivery of incentivized services, describing the performance framework as well as their roles and responsibilities in relation to PBF;
b. To assist the District Council Secretary with signing contracts with the Government of Lesotho and CHAL health centers for the delivery of incentivized services, describing the performance framework as well as their roles and responsibilities in relation to PBF;
c. To assist health facilities to prepare business plans that are consistent with the incentivized services and with targets consistent with the facility and district catchment populations and to effectively use PBF earnings for the improvement of health service delivery;
d. To carry out on behalf of the PBF Unit the ex-ante verification of the delivery of incentivized services;
e. To assist the PBF Unit and District Councils in preparing and processing invoices for approval of services purchased so that payments to contracted health facilities can be effectuated according to the agreed Project Implementation Manual;
f. To support the District Health Management Team with its supervision tasks to assess the quality of care provided in participating facilities using the standardized quality assessment checklist;
g. To comply with existing MOH technical guidelines and procedures and those developed during the life of the contract;
h. To assist the PBF unit and the District Council in organizing its quarterly district PBF steering committee meetings, which includes extracting invoices from the PBF web-based application (to be developed through a separate consultancy), and in the analyses of trends and the production of comparative tables and graphs for further analysis.

4.3 Contribution to project development

a. To design, test, and implement a reliable and efficient system of ex-post verification that effectively and efficiently validates, on a quarterly basis, the quantity and quality of services provided, in collaboration with the PBF Unit, district councils and MOH M&E unit ensuring that the services - including the quality of the services -  that are being paid for have actually been delivered;
b. To consult regularly with PBF stakeholders and Development Partners on further improvement of the  PBF design;
c. To contribute to the Monitoring and Evaluation activities undertaken by the PBF Unit (the World Bank will recruit a separate firm to undertake on behalf of the MOH an independent impact evaluation of the project) ;
d. To develop a roadmap and implementation plan for scaling up the PBF project beyond the pilot districts;
e. To prepare the districts selected for the scaling up phase for implementation. It is expected that five or more districts in different parts of the country will be selected for the scale-up beginning in 2015. In the second half of 2014, the PPTA is expected to start preparatory actions, which includes conducting sensitization and training workshops for communities, health centres and their committees, hospital management teams and District Health Management Teams/District Councils, collecting baseline data and setting performance targets.
f. To contribute to the dissemination of best practices and lessons learned on the PBF in Lesotho to other stakeholders within the country and other parts of the world.

Team Leader -PBF expert

Economie de la santé
Long term
Fin du recrutement
Compétences requises
1. At least 5 years mandatory experience with designing and implementing  Performance Based Financing approaches in sub-Saharan Africa
2. University degree in social sciences, MD or nursing degree with advanced basic training in PBF
3. Trained as a trainer for PBF
4. Ability to work independently and effectively in high-pressure, fast-paced environment and handle multiple tasks simultaneously whilst mentoring a team to perform consistently;
5. Fluency in English (verbal and written)
Durée de la mission et date de démarrage
4 years starting from 02/2014
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