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

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.