1. Performance Based Financing
Rapid Results Health Project
In
South Sudan
Dr. Sarla Chand & Dr. William Clemmer
Core Group Fall Meeting
October 16-17, 2013

2. Our History
• Founded in 1960 as “Interchurch Medical Assistance”
• Founded by 6 Protestant mission organizations
• Purpose: Procurement and distribution of medicines and
medical supplies to medical missions all over the world
• Today: IMA has grown to manage our own health and
development programs in Africa and Haiti
1960
Today
2

3. Core Competencies
• Health Systems Strengthening (HSS) – Rebuilding the
health system in nations especially those recovering from
war, disaster, and struggling with poverty
• Capacity Building – Empowering and partnering with local
governments, partners, faith-based organizations, and
health workers to strengthen health services delivery
• Disease Prevention and Control – Control/elimination of
HIV/AIDS, Neglected Tropical Diseases (NTDs), malaria, and
Non-Communicable Diseases (NCDs) such as cervical cancer
and Burkitt’s Lymphoma(childhood cancer)
• Procurement and Distribution – Cost effective, expert
supply chain management with strategic global distribution
of over $1 billion in medicines and supplies to date
3

4. South Sudan
Landlocked
Population: 10-13m
Young Population:
72% under 25 years

5. 32 Years of Civil War
• 2.5 million killed
• 4 million displaced
• Health care system
collapsed
• Weak education
system/low literacy
• Weak Infrastructure
July 9, 2011
Independence Day

6. SCOPE of Rapid Results Health Project
Two States – UN & JG
Twenty Four Counties
284 Health Facilities
3.1 Million Persons
$7.40 per capita investment

7. PBF/PBC
• PBF…….performance based financing
– ‘PBF’ we mean programs including incentivized
payments, additional financial resources, reinforced
supervision and increased managerial autonomy.
– ‘PBF’ is financing that shifts attention from inputs to
outputs, and eventually outcomes, in health services..
– Pay-4-Performance
• PBC……performance based contracting ( tool)
– PBC is the tool to operationalize forms of Performance
Based Financing

8. Implementation Timeline for PBF/PBC
January 2013
January 2012
July 9, 2011
October 2010
PBC with CHDs
Independence
Oil shutdown
PBC with HFs

9. Performance Q1 JG State

10. • Results in Jonglei State ( 1st 6 months)

11. • Results in Upper Nile State (first six months)

12. Incentives and Ante-Natal Care
•
•
•
•
RBF……
PBC……
PBF…….
IBF……..
Incentives and Ante-Natal Care Performance
P-Values - UN: < 0.0001 and JG: < 0.0041

13. Incentives and Curative Care for
Under-Fives
•
•
•
•
RBF……
PBC……
PBF…….
IBF……..
Incentives and Curative Care for Under-Fives
P-Values - UN: < 0.0018 and JG: 0.9034

14. Incentives and DPT3
•
•
•
•
RBF……
PBC……
PBF…….
IBF……..
Incentives and DPT3 Vaccinations
P-Values - UN: < 0. 7374 and JG: 0.9727

15. Conclusions/Recommendations
1.
2.
3.
4.
5.
6.
7.
8.
HMIS Reporting from County Health Departments (CHDs) continues to be high
Q2 has shown an increase in payment (50% to 70%) to health facilities
Facilities noted that the PBC payment often made the difference between the facility
being open and closed! (they could depend on being paid)
Open HFs and motivated health workers encourage people to access services as shown
by increase in curative care and ANC rates
Despite the challenges of continuing conflict in Jonglei state PBC does show some
improvement in services
Due to the contextual challenges the health facilities cannot be given funds and expected
to procure essential drugs and commodities on their own.
Ongoing training is essential for refreshing and building capacity of continuing staff but
also due to high turnover of personnel.
It is difficult to isolate and lift up the impact of PBF as a system and the fact that for
many this is the only payment they receive on a regular basis

16. Thank You