Burundi - Health Sector Development Support Project (Anglais)

Ratings for the Health Sector Development Support Project for Burundi were as follows: outcome was satisfactory, Bank performance was satisfactory, and monitoring and evaluation quality was substantial. Some lessons learned included: health reforms such...  Voir la suite Ratings for the Health Sector Development Support Project for Burundi were as follows: outcome was satisfactory, Bank performance was satisfactory, and monitoring and evaluation quality was substantial. Some lessons learned included: health reforms such as performance-based financing (PBF) based reforms benefit from a period of piloting well designed and well-implemented schemes at a small scale prior to scaling up, as was done in Rwanda, and in Burundi. Linking PBF reforms to country commitment to finance health through similar methods was successful. The design of the financial agreement between the Government of Burundi (GoB) and the World Bank (WB) for this project can be considered good practice. Linking funds for selective free health care (FHC) for pregnant women and children under five years of age and funds available for PBF based health reforms was also a winning formula. The ownership of the program at the local level supported resilience and rapid recovery after the crisis. Solid third -party counter-verification of internal ex-ante verification mechanisms is required and has been championed by this project. Systematic community client satisfaction surveys, like done in this project, provide good health intelligence and can be made operational to include in the quality index for performance measures. Decentralizing health financing to the frontlines, while enhancing autonomy through well-funded PBF approaches over a significant period, and especially when baselines are very low, can have dramatic positive results on health system performance. Autonomy in the management of human resources and breaking monopolies in the procurement of drugs and medical consumables are crucial preconditions for PBF to work.  Réduire