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Course Guide with 17 Modules Performance-based financing in Action Theory and Instruments Course Guide with 17 modules The institutional design such as found in many PBF systems Version October 2019 This PBF manual can be downloaded in English or French from www.sina-health.com PBF toolkit can be downloaded from the World Bank site: http://www.worldbank.org/health/pbftoolkit (website) https://openknowledge.worldbank.org/handle/10986 /17194 (free e-book in English or French language) PBF Course Manual Page 2 PBF in Action Theory and Instruments PBF Course Guide The components of the PBF black box SINA – 2019 PBF Course Manual Page 3 Ninth edition, 2019 Guide, Performance-based financing, health, health financing The contents of this publication can be reproduced if the source SINA is duly mentioned. Using this book for conducting courses is allowed when coordinated with Robert Soeters from SINA Health to assure that the latest materiel and methodologies are being used and in general to assure the quality of the course. Main Editor: Robert Soeters, PhD - SINA Health Contributors: Freddy BATUNDI, Dr. Michel BOSSUYT, Dr. Harmelle ENAME, Moussoume EKOUANGUE, Bwanga ENANDJOUM, Dr. Gyuri FRITSCHE, Christian HABINEZA, Frank van de LOOIJ Jean Baptiste HABIGUHIRWA, Sosthène HICUBURUNDI, Célestin KIMANUKA, Dr. Philémon MBESSAN, Professeur MUNYANGA, Pacifique MUSHAGULUSA, Dr Juvénal NDAYISHIMIYE, Dr Canut NKUNZIMANA, Dr Claude NTABUYANTWA, Dr Jean Paul NYARUSHATSI, Didier NTIRORANYA, Dr Peter Bob PEERENBOOM, Ernest Schoffelen, Dr Jean Pierre TSAFACK, René QUEFFELEC, Dr. Godelieve VAN HETEREN, Dr. Jannes van der WIJK, Dr Michel ZABITI SINA Health PBF in Action: Theories and Instruments, PBF Course Guide The Hague, 2019 If you want to forward comments, the results of your research or to get supplementary information, contact: SINA Health Kramsvogellaan 22 2566 CC, The Hague, the Netherlands Tel : +31 703 666 855 E-mail : [email protected] PBF Course Manual Page 4 Table of Contents ABBREVIATIONS ..................................................................................................................................................... 10 KEY INDICATORS IN PBF ..................................................................................................................................... 12 INTRODUCTION AND LE LINKAGE WITH UHC AND THE SDGS........................................................... 13 CONTENT OF THE MANUAL .......................................................................................................................................................................... 13 ACKNOWLEDGEMENTS.................................................................................................................................................................................. 15 THE HIERARCHY OF PRIORITIES IN PBF................................................................................................................................................... 15 THE COST TO FINANCE UNIVERSAL HEALTH COVERAGE, AND THE POTENTIAL RESOURCES ..................................................... 15 PBF AND CRISES SUCH AS WAR OR THE EBOLA EPIDEMIC .................................................................................................................. 17 PBF AND EDUCATION .................................................................................................................................................................................... 17 THE PBF APPROACH IS RECOGNIZED BY SEVERAL WORLD LEADERS ............................................................................................... 17 1. WHY THIS PBF COURSE, AIMS, EVIDENCE AND METHODOLOGY ............................................ 18 1.1 OVERALL AIM OF THE PBF COURSES AND TRAINING OBJECTIVES .................................................................................... 18 1.2 WHY THIS PBF COURSE? ............................................................................................................................................................. 18 1.3 THE HISTORY OF THE PBF COURSES ........................................................................................................................................ 18 1.4 COURSE METHODOLOGY ..................................................................................................................................................... 19 1.4.1 From the comfort zone towards becoming a change agent ............................................................................ 20 1.4.2 Learning strategies during the PBF course ............................................................................................................. 20 1.4.3 The participants’ action plans per country or theme ......................................................................................... 20 1.5 WHY IS PBF EXPANDING? ........................................................................................................................................................... 21 1.6 WHERE AND FOR WHICH SECTORS TO PROPOSE PBF?........................................................................................................ 21 1.7 THE ACADEMIC EVIDENCE FOR PBF ......................................................................................................................................... 21 1.8 REFERENCES ON THE ACADEMIC EVIDENCE ........................................................................................................................... 23 2. A SIMPLE EXAMPLE OF WHAT IS PBF & CHANGE TOPICS .......................................................... 24 2.1 HOW DOES PBF FUNCTION: A SIMPLE EXAMPLE OF A HEALTH CENTRE ......................................................................... 24 2.2 CHANGE ISSUES IN PBF AND FOR THE PARTICIPANTS ......................................................................................................... 26 2.3 HOW DOES PBF RELATE TO PRIMARY HEALTH CARE AND THE BAMAKO INITIATIVE ............................................... 26 3. DEFINITION PBF, BEST PRACTICES AND EQUITY INSTRUMENTS ............................................ 28 3.1 PBF DEFINITION ............................................................................................................................................................................ 28 3.2 HOW DOES PBF WORK: THE 11 BEST PRACTICES ................................................................................................................ 28 3.2.1 Separate the Functions among the Main System Stakeholders ..................................................................... 29 3.2.2 Competition for Contracts ............................................................................................................................................... 29 3.2.3 Public-Private Partnerships, Non-Discrimination and Principal & Secondary contracts.................. 30 3.2.4 Regulators’ Role to Define Indicators, Cost Budgets and Assure Quality and Competition .............. 30 3.2.5 Autonomous Management of Facilities ..................................................................................................................... 30 3.2.6 The Importance of Balancing Facility Revenues and Expenses...................................................................... 31 3.2.7 CDV Agencies Negotiate Contracts and Coach HF to apply Management Instruments ..................... 32 3.2.8 Local NGOs defend the Consumer Interest & Social Marketing ..................................................................... 32 3.2.9 Seek Efficiency Gains by paying Cash and let Providers Freely Choose their Inputs ............................ 32 3.2.10 Economic Multiplier Effects to stimulate Local Economy and Generate Tax Revenues ................ 33 3.2.11 Extend Performance Contracting towards other Sectors than Health ................................................. 34 3.3 THE PBF EQUITY STRATEGIES TO ATTAIN UNIVERSAL HEALTH COVERAGE ........................................................ 34 3.3.1 Subsidising positive externalities and public goods............................................................................................. 34 3.3.2 Giving market signals to providers to reduce curative care tariffs .............................................................. 34 3.3.3 Providing an equity bonus to vulnerable regions or districts ......................................................................... 35 3.3.4 Providing extra subsidies to vulnerable health facilities................................................................................... 35 3.3.5 Exempting the individual vulnerable.......................................................................................................................... 36 3.3.6 PBF response in the event of natural or humanitarian emergencies .......................................................... 36 3.3.7 How to identify the vulnerable? .................................................................................................................................... 37 3.3.8 Example of an operational manual for targeting the vulnerable from DR of Congo ........................... 37 3.3.9 Proxy means testing tool. Example from Kenya .................................................................................................... 38 3.4 TERMS OF REFERENCE FOR THE FIELD VISIT .........................................................................................................................
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