265004 Performance Based Contracting (PBC) of health services in Liberia: An early response to post-conflict settings

Monday, October 29, 2012 : 1:10 PM - 1:30 PM

Louise Mapleh, MPH , Director - Performance Based Financing Unit, Ministry of Health and Social Welfare, Monrovia, Liberia
Floride Niyuhire, MD, MPH , Rebuilding Basic Health Services (RBHS), Management Sciences for Health (MSH), Monrovia, Liberia
Bal Ram Bhui, MPH, MA, MBA , Rebuilding Basic Health Services (RBHS), Rebuilding Basic Health Services (RBHS), Monrovia, Liberia
Background: Since 2008, the Rebuilding Basic Health Services (RBHS) project supports the Ministry of Health and Social Welfare (MOHSW) in rapidly restoring service delivery after a long civil war had destroyed health infrastructure in Liberia. The project is funded by USAID and managed by JSI with partners. In response to post conflict physical and human infrastructure challenges, a performance based contracting (PBC) model was implemented, where national and international NGOs are contracted by RBHS to deliver the basic health services.

Methodology: Contracted NGOs receive an input of 95% of agreed upon funds to initiate delivery of health services; 5% of the budget is withheld pending validation of data, and an additional 6% bonus is allocated based on performance. NGOs ensure that health facilities (HF) in their catchment areas meet quarterly performance targets. NGOs and county health teams (CHT) verify services provided, while RHBS is responsible for validation of results, and MOHSW regulates the PBC model.

Results: After two years, substantial health service improvements have been seen in the PBC catchment areas: the rate of skilled birth attendance increased from 17 to 63%; pregnant women receiving 4 ANC visits rose from 37 to 91%; HF with no stock out increased from 0 to 88%; and 91% of HF pass the rational drug use assessment.

Implications: Building on many successes and lessons learned from RHBS project, MOHSW is now scaling up a harmonized performance based financing model throughout the country. The RBHS model has potential to be applied in similar post-conflict countries.

Learning Areas:
Administration, management, leadership
Public health or related laws, regulations, standards, or guidelines
Public health or related public policy

Learning Objectives:
1. Discuss the performance based contracting frameworks 2. Explain some of the performance indicators used in contracting 3. List issues with promoting performance based contracting in a post-conflict setting 4. Discuss implications of applying the RBHS model in similar post-conflict countries

Keywords: Performance Measurement, International Health

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: As the Performance-Based Financing Manager at the Ministry of Health in Liberia, I design and oversee the process of PBC. I advise various NGOs working with the ministry on implementing the PBC process
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.