ONDO STATE, November 5, 2015 – Ariyo Oluwatosin Raphael is one of several interns recently trained in the specifics of performance-based financing, an innovative mechanism to ensure results in primary health care delivery in Nasarawa, Ondo and Adamawa states, particularly for women and children.
As a relatively new approach to financing health service delivery, more PBF verification capacity was needed to support implementation in all three states. Through the Nigeria State Health Investment Project (NSHIP), a $170 million, 5-year project supported in part by the World Bank, an internship program was developed.
Below, Raphael shares his training and internship experience.
1. What are some of the key takeaways from your experience in the PBF internship program for verifiers?
I went in keen to learn the fundamentals of Performance-Based Financing. I also wanted to be able to apply the knowledge from the training, outside the learning environment.
The facilitators created an enabling environment to contribute to the issues or topics discussed, and positively encouraged interns whenever needed. There were role plays and a field exercise, where we visited the top-performing health facility in Ondo East to conduct both quality and quantity verification.
I knew I was going to do my part for the state and to make PBF successful.
2. Tell us about your work as a PBF verifier in Ondo State. What is a typical day like for you?
I conduct quantity verification of results or services delivered by health facilities to target populations – women and children – in Ondo East. These facilities have signed a contract to provide a package of healthcare services to the community. In order to track the performance of service delivery, it is necessary to verify that these services were actually delivered and, if so, at what level of standard.
I also mentor and coach health facility managers on how to best achieve their goals and objectives as stated in their business and action plans. This also includes training them to write their business plan.
3. What do you find most fulfilling about your work?
Being able to contribute to the transformation of the health sector in Ondo State. As a verifier, I have the opportunity to interact with health workers about PBF and I am happy that each time I find myself in the field conducting verifications, I can help health workers understand that sincere and enthusiastic work attitudes are what drive PBF success.
4. What are some of the challenges you encounter in your work?
One of the challenges I often encounter is transportation from one health facility to another within a local government area. Some health facilities, like Igbindo, Laoso (Ondo West), Kolawole, Orisumbare, Asatan-Oja (Ondo East), for example, have difficult terrain and are hard to reach during the rainy season. Also some health facility managers do not understand the process of implementing PBF strategies and find it insulting when a young man is politely telling them how things should be done; especially when the issue at hand has to do with the activities of their health facility.
5. What are some of the changes you’ve noticed in Ondo State, since the implementation of performance-based financing?
PBF has improved the quality and quantity of services in health facilities through the performance contract. Before PBF, public health facilities were not being used by the community due to lack of drugs and other medical and non-medical equipment, and attitudes of health workers to their clients/patients. The community preferred private health facilities and even the general hospitals. There was also a very weak referral linkage between the primary health facilities and comprehensive health facilities and general hospitals.
Performance-Based Financing has given the health facility managers the autonomy to procure, distribute and manage resources to best improve the health facilities and attract clients to use their services. They (health facility managers) can procure drugs and consumables based on the need of the health facility and this has drastically reduced the issue of drug wastage and stock outages.
PBF has brought a great revolution to the health sector in the state. The health workers now realize that they will be incentivized based on their performance/output/results. Through proactive advocacy visits to the stakeholders in each PBF implementing local government area, community leaders were able to convince the community members that the health facilities are now equipped and able to meet their needs. This has increased the number of outpatient consultations in basic and comprehensive health facilities, which now only refer complicated cases to the general hospitals.
6. Can you share a story that demonstrates the impact of PBF?
Yes -- the Fagbo Comprehensive Health Centre, Ondo East, was known for its poor performance before PBF. The health facility was not neat, toilet facilities were in bad shape, and the outpatient attendance was not encouraging. PBF has helped improve the facility’s performance: it recorded 481 outpatient consultations, 98 institutional delivery and 158 completely immunized children at the end of the fourth quarter of 2014 compared to the baseline figures of 30 institutional deliveries, 62 completely immunized children, 234 outpatient consultation (new and old users). The health facility manager has improved the standard of the facility and it has been given a new face: well painted and also with staff quarters. They also have a generator now, to make electricity available 24 hours-a-day!