How did Rwanda Operationalize Execution based Financing ?.

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How did Rwanda Operationalize Execution based Financing ?. Results Based Financing Workshop October 20-24, 2008 Gisenyi, Rwanda. I. Setting (before PBF). 1994-97: Remaking after the genocide (crisis circumstances, NGOs). For nothing out of pocket.
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How did Rwanda Operationalize Performance-based Financing ? Results Based Financing Workshop October 20-24, 2008 Gisenyi, Rwanda

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I. Connection (before PBF) 1994-97: Reconstruction after the genocide (crisis circumstances, NGOs). For nothing out of pocket. 1998-…Willingness to return to advancement and government initiative. Client expenses. 1999: wellbeing office pointers are degradating. 2001: Butare: ability to move far from settled reward and perception of heterogenous execution crosswise over wellbeing focuses.

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Chronology of Performance-based financing in Rwanda

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The PBF pilot tests (2002-2005) Led at common level. Global NGOs. Need wellbeing mediations: kid inoculation, ANC, helped conveyances, family arranging, healing consideration. Beneficiaries: wellbeing focuses. An expense for administration. E.g. 500 frw for a completely inoculated youngster X amount reported by the wellbeing focus.

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Scale up: Roll-out Phases

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Scale up/national approach 2005: GOR chose to scale up PBF in the whole nation; requirement for solid coordination; choice to set up a specialized working gathering to actualize the method: MoH Strategic Plan 2006: From harmonization to making a national model; PBF Budget line in the GOR spending plan; ICT administration devices; expansion to healing facilities.

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How did Rwanda direction accomplices to adjust installment? GOR: pays yields all through Rwanda through repetitive spending plan embedded, subsequent to 2007, a financial plan line thing for a PBF plan for the District Steering Committee exercises which are based at District level PBF administrator framework takes into account GOR and contributor monies to course through one channel: straight into the wellbeing office ledgers. E.g. MSH – USG contractual worker pays HIV PBF in same record as GOR. Utilization of same administration module, with database connected to installments. Different givers: ICAP-USG contractual worker, FHI and BTC do likewise.

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How did Rwanda direction accomplices to connection installment to comes about? A test: the HIVAIDS cash 3. Cautious appraisal of motivations through HIV monies in PBF: arrangement found by linking so as to secure PHC administrations installments of HIV and PHC monies to levels of nature of general administrations. Unit Fee * Quantity * % Quality = Payment; 4. Worldwide Fund is joining different accomplices in paying for HIV pointers into their upheld locales (R7); 5. One national methodology, same institutional set-up, same unit costs and same administrator framework encourages arrangement

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Payment to results: considering quality Monthly at the HC the amount/volume of exercises are surveyed (PHC & HIV); Once per quarter the Quality of 13 administrations at the HC is resolved (185 pointers!) ; Quantity * Unit expense * % Quality Index prompts the add up to be paid as execution to the HC;

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Institutional set-up

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Contractual courses of action GOR contracts have been composed at all levels: (i) between the Mayors and the region PBF directing panels (multilateral); (ii) between the neighborhood organization and the wellbeing focus administration boards of trustees and – sometimes (iii) between the wellbeing focus administration advisory groups and the individual wellbeing specialists.

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Administrative & administration coordination PBF administrator framework with web based information section and recovery encourage decentralized administration and future decentralized installments (by regions); Semi-computerized installment module, connected to focal database, witch take into account simplicity of installments by MOF (Ministry of funds) and others (MSH; BTC; FHI and GF); Central database considers taking after patterns and estimate precisely budgetary danger;

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ICT administration devices: INSERT GRAPHIC TO ADD MAP IS 6.17” TALL

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Monitoring and assessment Internal Controls by wellbeing offices and District (Quantity and Quality) is at times supplemented by ‘External Controls’ i.e. from outside the District. Conventions exist for counter-confirming Quality and Quantity information. A test/a hazard: No efficient control at group level.

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what number persons to do that? The current workload is too vast for any one single specialized office or understaffed and incline focal MOH office MOH focal PBF Unit (CAAC): 1 facilitator and two full-time staffs; A key part for accomplices (individuals from the CAAC and on the field) An Extended group methodology has been placed set up to cover 23 areas, and incorporates PBF central focuses from the MOH, eight NGOs and a reciprocal office as a coordination structure

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Results Increases in the Volume of Services Increase of the Quality of Services Increase of staff efficiency Provider Enthusiasm and Motivation

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Increase in Volume of Services (following 27 months)

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Results for Family Planning Users toward the Month\'s end

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FP Injections and oral systems at Health Centers % Increase in Prevalence more than 24 months; ( normal outright increment from 3.89% to 10.63%) January 2006 through December 2007

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Other upgrades Over 16 months of PBF, the Quality expanded by and large by 7% over these 13 administrations. A sharp increment in staff efficiency. Whilst all suppliers value the extra rewards that they gain through PBF, most additionally see clear favorable circumstances in the better administrations they give, and take clear pride and responsibility for exercises which start ‘from within’ instead of being managed from above.

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Some difficulties we met HIV/AIDS cash! Building agreement on pointers Existing players with their own models oppose change. Coordination of accomplices and exercises on the ground.

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Lessons Learned Start with simple things and afterward go logically to multifaceted nature. Requirement for solid execution situated coordination structures Need for making a huge pool of coaches Need for solid administration and political will from powers Massive increments in administration volume whilst keeping up or expanding the nature of these administrations is conceivable CBHI and PBF are synergetic! .:t

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