PERFORMANCE BASED FINANCING (PBF) – A SHORTER WAY TO ACHIEVING UNIVERSAL COVERAGE
Following series of negotiation meetings between the Adamawa State Government, the Federal Government of Nigeria and the World Bank that started since 2009, Adamawa State is finally included among the 3 benefiting States for the World Bank’s assisted Nigeria State Programmatic Investment Project (NSHIP) that will support the pilot Performance Based Financing (PBF) in Nigeria.
In preparation for the take-off of the project in Adamawa State, key officials from the Ministry of Health and the Adamawa State Primary Health Care Development Agency (ADSPHCDA) were trained on PBF at Enugu, Nigeria and in Mombasa, Kenya. Fufore LGA, a rural LGA with a secondary health facility, which has 11 (Three Wards were split into two: Mayo-Ine, Ribadu & Wuro-Bokki) wards and is close to Yola the operational base, was chosen as the pre-pilot LGA and baseline assessment of the communities and health facilities in the LGA was carried out. A total of 13 public and 1 faith based private Primary Health Care (PHC) facilities were selected for contracting of the Minimum Package of Activities (MPAs) based on the assessment, while the only secondary health centre, the Fufore Cottage Hospital was picked for contracting of the Complementary Package of Activities. In addition, the LGA Result Based Financing (RBF) steering committee, the 11 ward development committees, the 15 health facility management committees and the RBF committee for the Cottage Hospital were formed and inaugurated.
A formal launch of the pre-pilot was done between the 5th and 7th December 2011. During the occasion, all the representatives of the health facilities and their respective ward development committees were given an induction training on PBF, focusing on the purpose and making of a responsive business plans. At the end, the Adamawa State Government, represented by the Honourable Commissioner of Health signed a memorandum of understanding on PBF with Fufore LGA represented by the Acting Chairman of the LGA. The State Primary Health Care Development Agency also signed PBF contract with all the 15 participating health facilities, an agreement with the Local Government Authority Results-Based Financing (RBF) Steering Committee and Performance based financing (PBF) contract for the quality supervision of health services with LGA PHC Authority.
The facilities were the immediately followed up with on-the-job training focusing on general management and improvement of quality of care. A set of 15 improved patients’ registers were adopted, produced and distributed by ADPHCDA to all participating health facilities that are used for data capturing by facility staff and verification by the ADPHCDA staff. All the facilities opened their bank accounts and were advanced the sum of N385,000 to each PHC facility and the sum of N962,500 to the Cottage Hospital. The facilities are then allowed to operate using the knowledge from their induction training guided by their business plans.
At the State level, the State RBF Steering Committee, chaired by the Honourable Commissioner of Health and the State Technical Working Group, chaired by the Chairman ADPHCDA were formed and inaugurated in April 2012.
Following the 1st and 2nd quarter evaluations, the following results were noted: