Performance-Based Financing: A Win-Win for Health Care Personnel and Patients Alike

POINTE-NOIRE, January 19, 2017—In the waiting room of the Saint-Joseph Integrated Health Care Center in Pointe-Noire, the economic capital of the Republic of Congo, ten mothers are sitting on a bench listening attentively to a midwife’s guidance on caring for their babies’ nutrition and immunization. “I really appreciate the cleanliness of the facility, the punctuality of care takers, and the openness and seriousness with which the staff care for their patients,” says Daïna Nkouka, a 25-year-old mother attending the early childhood class.

Like 37 other approved integrated health care centers in Pointe-Noire that are covered by the Second Health System Strengthening Project (PDSS II) financed by the World Bank, the Saint-Joseph center has adopted the performance-based financing (PBF) system. This system subsidizes health care structures according to the quantity and quality of the care they provide. For Dr. Jean-Michel Ndzodault, Health Director for the Pointe-Noire Department, “Performance-based financing is effective because it benefits the service regulator, health care personnel, and patients. This means it helps improve living conditions for the whole community.”

Since performance-based financing was introduced, patients have noticed significant improvements: service delivery is friendlier, treatments have improved, and information campaigns, such as the class Daïna is attending, have been expanded.  “When I come to this center, I am confident that my day will not be disrupted and that I will pay the fees posted. In contrast, at other centers, you can waste a whole day, because the staff arrives late and ignores the patients, and the fees change all the time,” says Awa Dia, a young patient who gave birth at the “Le Bien-Être” or Wellness Integrated Health Care Center.

“Implementation of performance-based financing has clearly enabled us to improve the quality of care at our center, which has boosted patient numbers from 60 to 180 per month,” says Judycaëlle Dzongo, one of the center’s midwives.
Generally speaking, health care personnel have welcomed performance-based financing, which could mean more financial resources for centers if their performance meets certain standards.  A well performing center also qualifies to receive more medical equipment, medicine, and training to improve the quality of care. “Performance-based financing provides merit bonuses for health care staff so the harder you work, the more you earn. It helps ensure that the personnel are always motivated to do their best,” says Célestin Pembellot, Head of the Saint-Joseph Integrated Health Care Center.

“I take my job more seriously. The motivation bonus helps me cover my travel costs so I can be punctual at work. The evaluations and support provided encourages me to continue improving my skills. Helping patients is my number one priority,” adds Stevie Moussavou, a nurse at the “Hôpital” Integrated Health Care Center.

Performance-based financing covers three health districts in the Pointe Noire Department: Ngoyo, TiéTié, and Mvoumvou. All three received investment funds to modernize their technical wherewithal and equipment in order to increase their operating capacities. “We purchased twenty benches for the waiting room, a sterilizer, baby scales, other scales, three beds separated by curtains for the delivery room, and a well-equipped pharmacy. We are also making various improvements to the premises,” says Pembellot.

The Second Health System Strengthening Project totals $120 million over five years, including $100 million provided directly by the Congolese government. The World Bank has contributed $10 million through the International Development Association (IDA), its fund for the poorest countries. This contribution was backed up by a grant of $10 million from the Multi-Donor Trust Fund for Health Results Innovation, financed by the United Kingdom and Norway.

The objective of this project is to increase the utilization and quality of maternal and child health services in targeted areas with performance-based financing, which has already produced tangible results in many African countries.

The project is being piloted in seven of the twelve departments of the Republic of Congo (Brazzaville, Pointe-Noire, Niari, Bouenza, Pool, Plateaux, and Cuvette) and covers approximately 86% of the country’s population.

The project focuses on full immunization and growth monitoring of infants and children, treatment for malnutrition, medical monitoring of pregnant women and young mothers, HIV screening during pregnancy and treatments to prevent mother-to-child transmission of HIV, along with information campaigns on modern family planning techniques for couples wishing to space births.