Cordaid’s Country office in Sierra Leone has extended its health care program to the neighbouring country of Liberia.
As of January 2018, the Cordaid team in Sierra Leone supports the Liberian National Verification Agency in its Results Based Financing (RBF) project. The aim is to improve the quality of health care at hospital level.
The RBF program incentivizes hospitals based on the improved quality of care.
Reasons for poor quality health care in Liberia
Many hospitals in Liberia have operational challenges. They are in generally poor infrastructural condition, are understaffed, have long waiting times and lack equipment and drugs. Consequently, they provide low quality care. This is reflected in high levels of post-surgery complications and infection rates. But also in limited maternal and child death audits and no systematic use of clinical guidelines and protocols.
Poor quality of care is a primary concern. It leads to poor care and treatment and a waste of resources. To curb this situation Cordaid is providing Results Based Financing support to Liberia’s Health Systems Strengthening program.
How Results Based Financing can improve quality of care
Our support involves improving quality services delivery systems, a fit-for-purpose health workforce and support systems, through the National Verification Agency run by Cordaid. Cordaid staff in Liberia works under the supervision and with direct support of the Cordaid Sierra Leone office. Cordaid Head Office in The Hague is offering RBF consultancy services to the Liberian Ministry of Health through the NVA office. We do this at selected secondary hospitals in five counties (Montserrado, Bong, Lofa, Nimba, Sinoe).
A key strategy in the RBF program is that it incentivizes participating hospitals primarily based on the improved quality of care. Specifically, a Quality Assessment Tool will determine the quality scores for payment. This tool includes:
- 14 clinical process of care checklists across 4 areas – maternal complications, neonatal complication, pediatrics (in-patient), and surgery;
- a management checklist (e.g. the availability of drugs and equipment, infection control…);
- facilities also receive incentives based on the quantity of specific pre-defined health services delivered.
The objective of this assignment is to assure a clear separation of clinical and management functions and to improve the technical capacities of the participating hospitals. An independent National Verification Agency (NVA), was hired through a competitive process. This agency conducts quantity and quality assessments, reports on results, organizes community verification and subcontracts community based organizations to conduct client satisfaction surveys.
Advantages of a regional approach
Mohamed Sesay, Country Director of Cordaid Sierra Leone, explains how a regional approach – and applying knowledge and resources in similar contexts across borders – can exponentially increase social impact. “The challenge that often arises when in dialogue with partners and potential donors is the topic of scale and number of beneficiaries impacted”, he explains. “Using a regional approach in countries with similar contexts that share borders or have one country separating them—we increase direct beneficiaries and social/economic impact on an exponential scale. Liberia is our pilot for this new regional approach for Performance Based Financing in Health Systems Strengthening and we look forward to expanding other Thematic Intervention Areas into Liberia soon”.
Marketing Cordaid expertise
Polite Dube, the RBF NVA Technical Leader in Liberia says: “The most fulfilling part of the work so far has been putting RBF experience into action in a new context and marketing the expertise that Cordaid has in Health System Strengthening, particularly RBF”.
Derrick Chivinge, the RBF NVA Data Manager echoes this. “The most exciting part is exploring and discovering opportunities that contribute to more resilient health systems”, he says. “We hope to open doors to more opportunities for Cordaid in Liberia”, he adds.