263198 Outcomes of a performance-based contracting strategy in South Sudan

Wednesday, October 31, 2012

Erin Polich, MPH , Shtp II, Management Sciences for Health, Cambridge, MA
A. Frederick Hartman, MD MPH , SHTP II/South Sudan, Mangement Sciences for Health, Cambridge, MA
John Rumunu, MD, MPH , Shtp II, Management Sciences for Health, Cambridge, MA
Jemal Mohammed , Shtp II, Management Sciences for Health, Cambridge
Background: The USAID-funded Sudan Health Transformation Project's (SHTP II) goal is to improve health in South Sudan via rapid extension of the Basic Package of Health and Nutrition Services (BPHNS). The project achieves this by developing performance-based contracts (PBC) with 9 subcontracting partners (SCP) to support extension of the BPHNS. Methodology: In the second year of subcontracts, SHTP II introduced a new performance based contract (PBC) payment matrix. Quarterly SCP payments are linked to performance and evaluated through a scorecard analyzing 11 indicators covering both programmatic and management performance. Scores < 80%, remunerate only 95% of the quarterly payment; scores between 80 to 100% remunerate a 100% payment; Scores above 100% generate a 106% payment. Results: Since implementing this scorecard, SHTP II demonstrated an increase in performance of several indicators, over and above previous project increases. Coverage of DPT3 more than doubled in one year, increasing from achieving 9% per quarter of the annual <1 year coverage need in Q4FY10, to 19% in Q4FY11 one year later. First antenatal care visits jumped from 16% of the annual need per quarter in Q4FY10 to 22% in Q4FY11. Similar increases were achieved in Vitamin A supplementation, skilled deliveries, and family planning distribution. In Q2, only 2 counties (of 13 possible) achieved the bonus, whereas in Q3, 4 achieved the bonus and 7 in Q4. Conclusion: Performance-based contracting played a key role in improving performance and indicator achievement, even when operating in fragile states like South Sudan.

Learning Areas:
Implementation of health education strategies, interventions and programs
Planning of health education strategies, interventions, and programs
Program planning

Learning Objectives:
1. Articulate the procedure for implementing a successful performance-based financing health program in a fragile state 2. Discuss the effects of performance-based financing on indicator performance

Keywords: Performance Measurement, Financing

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have been the Country Lead on multiple international health projects focusing on lowering maternal and child mortality, improving primary health care, and implementing HIV programs. I am currently the Country Lead for the SHTP II project in South Sudan, focused on implementing a health project in more than 160 health facilities across South Sudan in order to assist moving the health sector from relief to development.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.