Results Based Financing Implementation Plan

The program, implemented by the Ministère de Santé Publique et de la Population (MSPP) in partnership with the World Bank and USAID, builds on the pilot program implemented by the USAID-funded Santé pour le Development et la Stabilité d'Haiti (SDSH II) project. The program is modeled after the Burundi and Rwanda RBF schemes. The Service de Santé de Qualité pour Haiti Central-South (SSQH-CS) project, funded by USAID, will implement the national RBF scheme in selected health facilities in central and south regions. However, several important financing and implementation factors need to be considered before the roll-out begins. Key challenges include the need for a 10% reduction in operating budgets of all 80 SSQH-CS supported facilities to provide the necessary funding to support RBF contracts. To address these challenges, SSQH-CS developed concept notes outlining financing and implementation options for MSPP and USAID to consider. RBF experts from USAID, LMG, SSQH-North, and SSQH-CS participated in a two-day workshop to discuss the various options outlined in the concept note. The implementation and financing plan outlined in this memo is based on a review of the concept notes and discussions and recommendations from the two-day RBF workshop. The objective of this memo is to outline concrete next steps that will guide the phased roll-out of the RBF scheme in selected SSQH sites from 2014 to 2016. SSQH-CS will implement the full complement of the MSPP's RBF indicators at the recommended unit-price, as prescribed in the RBF manual. To provide the necessary funding to support RBF contracts, SSQH-CS will implement a 10% reduction in the operating budgets of all 80 SSQH-CS supported facilities. The reduction in operating budgets will likely result in a decrease in the number of staff, salaries, community mobilization services, mobile clinics, and ability to respond to stock outs. This may affect the overall quality of services and ability of health facilities to manage overall operations. SSQH-CS will monitor these potential impacts closely and re-evaluate funding levels for sites after 6 and 12 months of implementation. In order to be compliant with the Tiahrt Amendment, SSQH-CS will implement the MSPP's recommended family planning (FP) indicator, but will need to rephrase this indicator in coordination with the MSPP and USAID. The implementation of RBF will be phased, with Phase 1 focusing on selected sites in Grand Anse and Nippes, and Phase 2 expanding to selected sites in the remaining departments. A blended approach will be used to make RBF payments to Zone Cibles, utilizing Options 1 and 3. SSQH-CS will utilize the existing MOU payment mechanism to disburse RBF incentives, while simultaneously moving forward with operationalization of direct sub-contracting with Zone Cibles. To process RBF payments directly to ZC facilities, a modification to the SSQH contract clause will be required. To move forward with the implementation plan outlined in this memo, SSQH will need support from USAID on the following: approval of the implementation plan, communication with MSPP on the proposed implementation plan, and contract modification to allow direct payments to GOH entities.