WASHINGTON, May 17, 2012 - The World Bank’s Board of Executive Directors today approved US$28.2 million to strengthen basic health services in the Central African Republic (CAR). This project aims to expand the use and improve the quality of health services in rural areas, with special emphasis on maternal and infant health care. Specifically, this financing will benefit at least 2.5 million people living in rural areas—nearly half of the Central African Republic’s population—over a four-year period.
Available data on the Central African Republic indicates that physical and financial access to quality health services poses a daunting challenge to the country’s health system. Maternal and infant health remains extremely poor, particularly in rural areas. Approximately 176 of every 1,000 newborns die before reaching age five.
Against this backdrop, the importance of this project lies in its implementation strategy, which revolves around two main areas—results-based financing (RBF) and monitoring and evaluation capacity building. The first area, linked to RBF, focuses on the conclusion of performance-based contracts between a performance purchasing agency (representing the interests of the health department) and public health facilities and faith-based non-governmental organizations (NGOs) working in rural areas. The payments made to these health entities will be tied to the volume and quality of the services provided to the target populations. The payment system will enhance the capacity to provide health services in the rural areas, with performance bonuses provided to health facilities. A portion will be used to keep these facilities operational and the other will be given directly to health workers in remote areas that have fewer resources.
The second component of the project focuses on boosting operational support within the Ministry of Health in order to build monitoring and evaluation capacity. This effort should lead to better implementation of performance-based contracts and strengthen the Ministry’s management of the health sector.
More specifically, Gaston Sorgho, Head of the Project Team based in Yaoundé, explained that “the RBF component will fund purchases of the main maternal and infant health services from public health facilities and faith-based and non-governmental organizations working in rural areas via a performance purchasing agency (PPA). This agency will enter into contracts with health units, health centers, health districts, and regional hospitals, with the aim of offering an agreed-upon package of preventive and curative maternal and infant health care services, and the hospital technical support services to health centers. The second component will build the monitoring and evaluation capacity of the health information system so as to better position it to provide reliable and up-to-date information that makes it possible to measure the performance of the health services at the different levels of the health pyramid.”
Taking into account the weak management of the public sector, a second important task of the performance purchasing agency will be to build capacity to manage PBRs at both the central and outlying levels.
Gregor Binkert, Country Director for the Central African Republic, states that “faith-based organizations, humanitarian entities, and national and international NGOs provide a significant volume of health services and are essential to the provision of health services, particularly in rural areas where they are represented in 75 percent of the health districts. In light of this, results-based performance represents a strategic approach that could enhance the coverage and quality of essential health services in the rural areas of the Central African Republic.”