The operation will finance: (i) district-level services using a performance-based contracting approach; and (ii) institutional capacity building for contracting, and for putting in place a unified monitoring and evaluation system.
It will address three critical impediments confronting the delivery of services at the district level: (i) scarcity of funds to meet operating expenses will be addressed by channeling financial resources to districts for operating resources to meet the day-to-day requirements of a district health system (e.g., supervision, community outreach, recruitment of contractual staff, bonus payments, consumables); (ii) lack of focus on achievement of results and lack of accountability mechanisms of the district health system will be addressed by pilot testing a few different approaches to performance-based contracting, including contracting of districts, Non-Governmental Organizations (NGOs), and health facilities; and (iii) modest managerial capacity at district level will be addressed by also pilot testing alternative approaches to strengthening district management, such as competitively recruiting private sector individuals.
This initiative will support the financing of performance based contracts (including financing of operating costs, goods, and technical assistance) between the provincial health funds and district health committees, NGOs or health facilities, contribute to the operating costs of the special funds for health promotion, and finance the procurement of required drugs, reagents and commodities to be done at the national level.
The project's focus on institutional capacity-building will include technical and financial support to strengthen two key normative functions of the Ministry of Health at the national, provincial, and district levels. Support will be provided in two main areas: (a) contract design and management, including setting up the institutional framework and systems and building capacity to prepare, negotiate, and manage contracts; and (b) putting in place a unified information system to generate up to date, reliable, financial and programmatic data.
The project will be initiated in 3 provinces (North-West, Littoral, South-West), and scaled up to 7 other provinces once funds are established.