VI. Panel Discussion on Health Financing: Health Service Contracting

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VI. Panel Discussion on Health FinancingHealth
Service Contracting Funding Mechanisms
Ministry of Health and Social Welfare Mr.
Benedict C. Harris Mr. Jacob J. Hughes July 16,
2008
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Overview of Presentation

• MOHSW health service provision financing
• Status update on contracting developments
• Status update on pool funding mechanism
• Linkages between pool fund and contracting
• Next steps

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Status update on health service contracting

• National Health Plan commits MOHSW to guiding
  partnerships with NGOs FBOs through conventions
  or contracts.
• The three stages of developing health service
  contracting include
• Situational assessment of contracting environment
• Contracting framework options
• Tools for implementation

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Status update on health service contracting

• Findings from the May 2008 situational
  assessment
• Purpose to inform the development of the MOHSW
  strategy, contracting policy and implementation
  design
• Methodology desk research in-country focus
  group discussions and interviews
• Findings
• MOHSW leadership is essential for success
• INGOs can be used to building local NGO capacity
  to successfully manage service provision
  agreements
• MOHSW contracting management capacity can be
  strengthened through additional training and
  systems strengthening
• MOHSW capacity for contracting will precede
  county capacity
• MOHSW is building capacity in regulation and
  oversight, but need standardized reporting
  formats and an integrated HMIS

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Status update on health service contracting

• Exploration of MOHSW contracting framework
• Contracting options
• Contracting in when one level of government
  contracts with a lower level of government to
  provide services
• Management contracting when government contracts
  with another party to provide management services
  at a government facility
• Contracting out when government contracts to
  another party to provide all services from
  government or private facility
• Payment mechanisms
• Prospective fixed amount paid for specified
  activities and achieved results
• Retrospective fee-for-service
  reimbursement-payments for services provided
• Stages in contracting

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Status update on health service contracting
PRE BIDDING PROCESS
STAGES IN CONTRACTING
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Status update on health service contracting

• MOHSW Key Contracting Tools
• Performance based contracting agreement document
  tailored to MOHSW needs
• Estimated resource requirements for direct
  service provision at health facilities.
• Monitoring and evaluation tools.

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Status update on health service contracting

• Possible contracting considerations
• Consider piloting combined approach of
  contracting in, contracting out and management
  contracting to learn what works best in Liberia
• Consider piloting both contracting payment
  methods (prospective and retrospective) to
  determine which functions better in Liberia
• Consider combinations of different approaches and
  methods

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Status update on pool funding mechanism
Status of Health Sector Pool Fund
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Status update on pool funding mechanism

• Key achievements to date
• Fund established in March 08 with an initial 8
  million USD contribution from DFID to increase
  the resources available to fund the unmet
  priorities of the National Health Plan.
• Steering Committee established in April 08 to
  provide input and to ensure proposals for pool
  fund use are consistent with the National Health
  Plan.
• Pool Fund Manager and secretariat in place to
  support MOHSW management and oversight of fund
  use.

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Status update on pool funding mechanism

• MOHSW use of the pool fund
• Increase resources available to the MOHSW to
  implement unfunded priorities of the NHP.
• Initial allocations made
• Start-up funds to re-establish Curran Hospital
  midwifery school
• Funds to establish a National Reference
  Laboratory
• Future allocations
• MOHSW working to develop an annual allocation
  plan to increase transparency and improve
  planning.
• MOHSW anticipates that implementation priorities
  established at this Review Conference will inform
  the annual plan

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Status update on pool funding mechanism
Process flow of pool funding
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Status update on pool funding mechanism

• Steps to strengthen communications and
  transparency
• Have invited national and international NGOs on
  to the Steering Committee as observers.
• Establishing a pool fund web page at the MOHSW
  website (www.moh.gov.lr) which will be updated
  with planning tools, Steering Committee minutes,
  funded activities, risk assessments, etc.
• Working to develop a simple news letter with key
  information.
• Will soon be publishing a pool fund procedures
  manual and 1st interim report that will be put on
  the website.

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Linkages between pool fund and contracting

• Commonalities between contracting and the pool
  fund
• Both increase the MOHSW stewardship of sector
  resources and activities.
• Both geared towards improving performance and
  expanding access to effective health services.
• Both can be leveraged to expand MOHSW capacity to
  deliver.

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Potential Next steps

• Contracting
• Take policy decision on how to proceed
• Sector assessment of available services
• Decide what priorities could be contracted
• Decide a contracting approach for each priority
• Design, implement, evaluate
• Pool Funding
• Develop a flexible, annual plan for use of pool
  funds
• Seek approval from Steering Committee for the
  annual plan and implement

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Thank you.