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The challenge of scaling up & integrating RBF

1/9/2017

15 Commentaires

 
Bruno Meessen
In late 2014, the Alliance for Health Policy and Systems Research along with the Department of Health Governance and Financing,  WHO launched an implementation research program “Taking Results Based Financing from scheme to system”. The main purpose of this program was to generate research knowledge useful for all the countries engaged in scaling up their Results-Based Financing (RBF) programs. The research is now over and the program has entered its dissemination phase. The Performance Based Financing Community of Practice supports the communication effort of this multi-country program of research.

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As far as low-income countries are concerned, the first applications of the Performance Based Financing (PBF) approach can be tracked back to the late nineties in pioneer countries such as Haiti and Cambodia. Over the next 20 years, the strategy has grown in popularity and has been adopted by an increasing number of countries. Some early adopters, like Rwanda or Burundi, rapidly transitioned from a pilot experience to a national policy. In some other countries, the adoption is much more recent, things are simply taking more time and in others RBF has failed to come on to the policy agenda.

The policy process through which a country moves from the idea to test RBF to a fully-fledged national policy is far from straight-forward. It is about developing a proof of concept, addressing national public health problems, gathering support among a large set of stakeholders, raising funds… So far, knowledge on how to overcome all these obstacles has not been systematized and synthesized.

When reflecting on the expansionary policy development of a RBF or PBF scheme, it is also important to put it into perspective. PBF is not an end in itself – it is a strategy to improve performance of the national health system, in terms of outcomes for the population, general efficiency and equity. Therefore, the issue of scale up must be understood in a broad sense: policy makers and analysts have to take into account the necessity to integrate the strategy in the broader effort to establish a coherent national health financing system as opposed to expanding a scheme as a narrowly focused intervention framed as an end in itself.

It is with this two main considerations in mind that  the Alliance for Health Policy & Systems research spearheaded the research program “Taking Results Based Financing from scheme to system”. The research was carried out in 2015 by national teams from 11 countries: Armenia, Burundi, Cambodia, Cameroon, Chad, Kenya, Macedonia, Mozambique, Rwanda, Tanzania, Uganda. The program was funded by the Alliance for Health Policy and Systems Research supported by NORAD with technical support from a team based at the Institute of Tropical Medicine, Antwerp.

Many of you contributed to this process, as researchers or as key informants. Some of you have already heard about our findings at  international conferences, in Dar-Es-Salaam, Harare, Rabat and Vancouver. But many of you are also active in countries not covered by the program or have missed our face-to-face events. There will be three channels to catch up. We of course recommend that you  use these opportunities together:  indeed they complement each other well.

Webinars


We have agreed with Joël-Arthur Kiendébréogo and Nadège Ade, the editorial team of the CoP webinar series, to organize a series of webinars to present some key findings.

The first webinar will introduce the research program. It will be presented by the two scientific coordinators of the program (Zubin Shroff and myself). In this webinar,  we will present the research program as a whole as well as the main lessons learnt.. Among other things, we will present the multi-dimensionality of  scale-up (it is much more than covering the whole country!), we will propose to analyze any PBF scale-up as a process going through four main stages and provide an overview of barriers and facilitators for scaling up a RBF scheme. We believe that this is strategically useful information to all those of you directly or indirectly involved in the design, implementation and study of PBF schemes.

With 11 countries, we have potentially a large number of country cases to present. Our intention therefore is to organize a few webinars focusing on some country cases. The actual number of cases will partly depend on the interest observed at the first webinar.

We will schedule these different webinars in the weeks to come. Note that the first webinar (general presentation of the research program) is scheduled for January 18th 1-3 pm, GMT. It will be in French and you will have to connect here. The same content will be presented in English on January 20th (1-3 pm GMT  as well).It will be here.  We recommend you to save the dates in your agenda. For more detailed and up-to-date information, it is recommended to register to our PBF online forum.

As a reminder, a webinar consists of a 60-90 minute online session with a power point presentation and a discussion at the end. To participate, you will have to install the WebEx program on your computer and have a sufficiently good internet connection at the time of the session. More guidance is provided here. The webinar team is also ready to help those for whom it is the first WebEx webinar ever, but you must alert them in time. You contact them here.


Policy briefs


The case studies carried out in the 11 countries provide a wide range of experiences. We have selected three interesting cases, at different points of the scale up process for illustration through  policy briefs. They are about the story of Chad (where the PBF pilot project never transitioned to a national program), the experience of Cameroon (which had to transfer the purchasing capacity from external actors to regional semi-autonomous entities) and the full scale-up of Armenia (whose PBF program was integrated within a plan of Primary Health Care revitalization, including in it a non-communicable disease component). A fourth policy brief synthesizes the enablers and barriers to scale up identified from the review of ten country experiences.  

These policy briefs will be officially published in the weeks to come. They will be introduced here on Health Financing in Africa. We hope that they will be useful materials for your own policy development or teaching.


Papers


Finally, we have agreed with the journal Health Systems and Reform  to develop a supplement consisting of  a series of papers presenting findings from our multi-country program. This is of course a venture demanding a bit more time, as papers have to go through a rigorous peer review process. We expect the first papers to be published in Spring 2017. We will of course keep you informed of their publication.

15 Commentaires
BALY
1/12/2017 01:47:39 pm

Heartfelt thanks for this great job that you have achieved.
As I haven't got your paper my query is to know how the private sector can play a role in the implementation of this scheme.

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6/14/2025 03:46:05 am

Advocacy groups like MRC, short for Media Research Center, which runs NewsBusters, have been arguing against NPR and PBS for decades, asserting that the taxpayer funding is unnecessary and unfair.

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❤️일본여대생출장만남➡️쭉쭉빵빵~24시항시대기중❤️ link
6/14/2025 03:47:09 am

The core contention is that publichttps://www.healthsystemsreform.com/ broadcasting is infected with liberal bias and thus is not representative of the public

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❤️일본여대생출장만남➡️쭉쭉빵빵~24시항시대기중❤️ link
6/14/2025 03:48:26 am

The leaders of NPR and PBS reject that charge. “One of the advantages of public media is that we serve everyone, and it is a requirement and a mandate. It’s also a very important mission in polarized times,” NPR CEO Katherine Maher told CNN.

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❤️일본여대생출장만남➡️쭉쭉빵빵~24시항시대기중❤️ link
6/14/2025 03:48:46 am

One challenge with trying to be a middle-of-the-road platform is that “people don’t agree on what the middle is now,” she added.

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6/14/2025 03:49:07 am

But the belief that PBS and NPR “spread radical, woke propaganda disguised as ‘news’” (something the Trump White House claimed earlier this year) has become close to GOP orthodoxy. Trump has directed his administration to bring public media to heel, sparking several lawsuits this spring.

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6/14/2025 03:49:56 am

The rescissions package strips all federal funding from the Corporation for Public Broadcasting, which distributes taxpayer dollars to radio and TV stations across the country. If the package passes the Senate, it will be a victory both for Trump and for generations of conservative activists.

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❤️일본여대생출장만남➡️쭉쭉빵빵~24시항시대기중❤️ link
6/14/2025 03:50:15 am

“For decades, Republicans have promised to cut NPR, but have never done it, until now,” Trump boasted in a Truth Social post on Thursday.

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6/14/2025 03:50:37 am

MRC’s call-your-congressman website tooki a similar tone: “This could be our last, best chance to win the battle once and for all.”

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6/14/2025 03:50:54 am

Republicans have been trying to take the “public” out of public broadcasting for almost as long as the system has existed.

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6/14/2025 03:51:16 am

In the 1998 book “Made Possible By…: The Death of Public Broadcasting in the United States,” James Ledbetter chronicled how Nixon’s administration had a “smoldering animus against public television” that erupted several times in the early ’70s.

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❤️일본여대생출장만남➡️쭉쭉빵빵~24시항시대기중❤️ link
6/14/2025 03:51:54 am

ixon vetoed two bills relating to the system’s funding structure. But even his veto memos defended the existence of public broadcasting and said it needed to be “strengthened.”

Reagan, and later George W. Bush, also proposed cuts to the system’s budget and tried to

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