Lessons learnt P4P Tanzania

Frank van de Looij – CORDAID (www.cordaid.nl)

05/01/23 2

Tanzania approach• Pilot because

– Positive experiences in Rwanda/Cambodia– More emphasis on outcome of funding

• 5 dioceses• 5 indicators

– IPD, OPD, Deliveries, VCT and drug stock outs• 0,5 USD per capita

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Tanzania approach

• 50% fixed and 50% based on performance– USD42,000 for hospitals (5% -10%)– USD14,000 for health centres – USD7,000 for dispensaries (20% - 30%)

• Criteria for spending funds• Verification• Funding through diocesan health offices

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Project Output

0.00.10.10.20.20.30.30.40.4

visi

t per

cap

ita

2004 2006 2007 2008(proj.)

Health Centers

OPD Utilization (HC/Disp)target 0,6 visit per capita

0

5

10

15

20

25

30

35

In-p

atie

nts

per 1

000

popu

latio

n

2004 2006 2007 2008 (proj.)

Hospitals

IPD Utilization (Hospitals)target 40/1000 population

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Project Output

VCT per 1000 pop

0

2

4

6

8

10

12

14

2004 2005 2006 2007 2008

Delivery per 1000 pop

0

1

2

3

4

5

6

7

2004 2005 2006 2007 2008

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Comparison P4P and non P4P Health centres

0,00

0,05

0,10

0,15

0,20

0,25

0,30

0,35

0,40

0,45

0,50

No

of v

isits

per

per

son

per y

ear

Mwemage HC(M)

Kiagara HC (G) Rwanbiazi HC(M)

Nkwenda HC (G)

Health facility

HC Utilization (M & G)

2005

2006

2007

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Lessons learnt

• Autonomy:– Most important principle of PBF– Misunderstanding about meaning– Reluctance by donor to let go– Reluctance by partner to take management role– Hard to combine with non-decentralized health

system

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Lessons learnt

• Choice of indicators:– Keep number limited (but depends on capacity)– More attention for preventive care– VCT not a good indicator– Include quality– Reduce risk of perverse effects

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Lessons learnt

• There needs to be a direct link between performance and bonus– Payments in time– Bonus is seen as entitlement– Bonus too small

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Lessons learnt

• Participation– Community– Facilities (see Rwanda case)– Other stakeholders– Local Government

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Lessons learnt

• Introduction needs to be combined with capacity building– HRM, financial management, general management– Planning (business plans, CCHP)– Toolkit for introduction

• DHO/facilities but also local technical assistance

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Lessons learnt

• Absence of local fund holder:– No context specific solution– Delay in disbursement– Little flexibility