Monitoring, data validation and verification

1. Monitoring, data validation and verification

3. Performance Indicators Defined • Health Center: • Performance Earnings = (Σ Services * Unit fees) * % Quality • 14 PHC indicators + 10 HIV indicators; unit fees $0.18-$8.90, measured monthly • 111 composite indicators (1,058 data elements) across 14 services/departments, measured quarterly • Case-based Reimbursement/Fee for Service type • Unit value for each Service • Hospital PBF model: • Balanced score card approach: (2009) 59 composite indicators, over 350 data elements • Annual global prospective budgets between $59K- $315K • Transparent peer-evaluation mechanism

4. PBF Control is NOT ‘business as usual’ in data gathering

5. Systems in place • Internal Controls by health facilities and District teams: • Quantity • Quality • Sometimes complemented by ‘External Controls’ i.e. from outside the District. • Protocols exist for counter-verifying Quality and Quantity data.

6. Health Center Quantity Control • Facilities report their monthly indicators to the district PBF steering committee • District controller passes by and checks: the quantity/volume of activities are assessed (PHC & HIV) • content • verifies in the various register books and patient files whether the amounts claimed are consistent with the documentation in the registers. • A monthly invoice is prepared by every health center

7. Monthly basic health service PBF invoice

8. Health Center Quality Control • The Quality Supervisory Tool consists of 14 elements • Once unannounced evaluation per quarter • Each element checks: • basic package of health services, • general administration. • The structural and process indicators are based on the Rwandan clinical practice guidelines. • There are 118 composite indicators, leading to a final composite quarterly quality score for each Health Center • Quantity * Unit cost * % Quality leads to the amount to be paid as performance to the HC;

9. Services and Weights Used to Construct the Quality Score for PBF Formula

11. Quality evaluation tool

12. Data audit and validation • Data audit are executed for both quantity and quality PBF indicators • Data audits are • Internal (district) by a rapid evaluations; • Or externally by a third party company. • Rounds of contra-verification are executed for PBF quantity and quality indicators through a contract with a third party agency • National community client satisfaction surveys are carried out nationwide • elicit feedback from clients on the quality of services rendered • deter health workers from reporting phantom patients

13. M&E/Payment • (validated Quantity * Unit cost) * % Quality leads to the amount to be paid as performance to the HC; • A district PBF Steering Committee meet to validate the data and the invoice; • The District Mayor send the consolidated bill of all the districts health facilities to the MOH • The payment is proceed directly into the bank account of the health facility

14. M&E/Supporting Mechanisms • A TWG and an Extended team approach has been put in place • as a coordination structure • cover all districts, • included PBF focal points from the MOH, NGOs • Monthly half day meetings, with short duration intense workshops • to operationalize the new national PBF model, • to plan the supervisions together • assess the needs

15. Challenges • Process of building consensus on indicators is hard • No systematic control atcommunitylevel