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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
05/01/23 3
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
05/01/23 4
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
05/01/23 5
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
05/01/23 6
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
05/01/23 7
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
05/01/23 8
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
05/01/23 9
Lessons learnt
• There needs to be a direct link between performance and bonus– Payments in time– Bonus is seen as entitlement– Bonus too small
05/01/23 10
Lessons learnt
• Participation– Community– Facilities (see Rwanda case)– Other stakeholders– Local Government
05/01/23 11
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
05/01/23 12
Lessons learnt
• Absence of local fund holder:– No context specific solution– Delay in disbursement– Little flexibility
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