Seven takeaways from the ICT 4 RBF meeting in Bujumbura, Burundi
Are you interested in RBF and ICT, but didn’t have the chance to attend the ICT 4 RBF meeting in Bujumbura, Burundi organized by the PBF Community of Practice and the Joint Learning Network? In this blog, Nicolas de Borman will try to summarize the (rather dense) discussions in seven takeaway messages.
Four years ago, Bujumbura hosted the first Performance-Based Financing (PBF) Community of Practice (CoP) meeting. At that time, PBF had been implemented in only six countries and the PBF CoP counted 50 members. This time around the picture is very different: PBF has been implemented in 17 countries on the continent, and the Africa PBF CoP counts more than 1300 members. For the CoP members, it was a real pleasure to meet again in Burundi and share implementation experiences.
Over the last four years, technology has not been a central concern for RBF managers. System design and implementation were the key priorities, and rightly so. In 2014, both RBF and mobile health technologies have developed further, and synergies of using new technologies for RBF are looking increasingly attractive.
In general, CoP meetings tend to bring together individuals with a strong background in supply-side RBF implementation. Interestingly, among the 65 participants this time, there was quite a variety of profiles, with experts in demand-side financing, ICT interoperability, health insurance, and mobile health. This mix of complementary expertise enhanced the quality of the technical discussions.
So what are the takeaway messages?
- Forget paper-based data collection; smart data collection is the way to go. Most of the RBF systems rely on paper-based data collection, in particular for quality of care and verification processes. During the meeting, Rwanda, Burundi and Malawi shared several examples on how mobile devices improve data collection. Mobile data collection has several advantages over the paper-based process: data entry errors can be immediately detected, all the data elements from surveys are collected, instant feedback to patients or providers is possible, and additional information such as pictures or videos can be collected. Technologies such as LimeSurvey, opendatakit, formhub, commcareHQ or Akvoflow have been presented and are available for enhancing your RBF data collection.
- Which open source supply-side RBF system should you choose? OpenRBF like in Benin or Burundi or DHIS2 like in Rwanda or Laos or an integrated solution like in Zimbabwe? There is no simple answer to this question. Participants agreed that DHIS2 is an attractive tool since more and more countries are moving their Health Management and Information System (HMIS) to this instrument. Unfortunately, currently DHIS2 supports only limited RBF features. So, the answer given during the meeting was to consider the RBF module of DHIS2 that is currently being developed if your RBF system is relatively simple, but go for OpenRBF if your RBF system is complex. Interestingly, this answer might be different a year from now: several IT teams in the CoP are currently working together on the design of an advanced DHIS2 RBF module that would manage more RBF features such as complex payment formulas or verification.
- And what about ICT for conditional cash transfers or e-vouchers? Mobile technologies can improve efficiency and reduce transaction costs of demand-side financing RBF. Examples of e-vouchers in Ethiopia and Mozambique and in Zimbabwe highlight the potential of technology for demand-side financing, but also draw attention to the challenges such as low mobile phone ownership or dysfunctional mobile payment systems. Are there open-source tools available for managing demand-side financing? For the moment, the answer seems to be “no”. The DHIS2 tracker and CommcareHQ seem to be interesting building blocks for such an instrument, but the CoP acknowledged that further work is needed to build standard solutions.
- Avoid data silos: think about ICT interoperability from the very beginning of your ICT implementation. Currently, most RBF systems are data silos, since they are not connected to other systems. There was a consensus among participants that an RBF ICT system should be interoperable with other ICT systems such as the HMIS, human resources databases, or other health financing systems. Examples like Rwanda highlighted why it is important for a country to define a national data architecture that will help connect any database in the system. Interoperability at country level starts with the design of national registries (i.e. a single database for health care facilities), definitions (i.e. definition of an assisted delivery) and communication standards. Open-source tools such as Resource Map or OpenHDD can help create these building blocks. Several CoP members are also working together on a standard taxonomy for health results and outputs that will facilitate interoperability both at country and regional levels in the future. CoP members decided to work together actively, such in Burkina Faso, on ensuring interoperable RBF and HMIS systems.
- Supply-side RBF, demand-side RBF, and health insurance ICT systems have a lot in common. Provider management, claim processing, budget management, or fraud and verification are part of all these systems. The PBF CoP has traditionally brought together supply-side RBF experts. In this workshop, the presence of Joint Learning Network members, with their in-depth health insurance expertise and experts with demand-side RBF experience was extremely valuable. Our lesson learnt: we will try to facilitate these synergies even more in the future.
Are mobile payments ready for RBF? Beyond the hype around mobile payments, CoP experiences have been mixed so far. It is fair to say that the Kenya success story is not a continental reality yet. In many countries, mobile payments systems are hindered by regulations (like in Burundi where only banks can deliver money), high transaction costs, fragmentation of mobile operators, or lack of liquidity in the mobile payment system. However, there were also successful examples like Mali where health insurance premiums are collected through mobile phones in what proved to be a fairly straightforward technical process. In other words, mobile payment is promising but still challenging in many of the countries.
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- Was the next Mark Zuckerberg in the room inventing the next disruptive system? Four innovations impressed participants:
- Benjamin Nyange from DRC developed an SMS-based verification questionnaire for patients and tested it during the workshop.
- Cordaid is reinventing community participation: the NGO is developing a multi-sector RBF project in South Kivu, in which communities decide, through the use of mobile phones, in which sector RBF funding will be invested.
- Terres des hommes presented how ICT supports nurses in 250 remote facilities of Burkina Faso, which can be a powerful tool for performance evaluation.
- HDP from Rwanda presented how smart cards and Point of Sale terminals can support data management without computers
Overall, the evaluation of the workshop was very positive: 31% of the respondents found that the workshop exceeded their expectations while 69% found that the workshop met their expectations. So, the last takeaway message might just be this one: join us for the next CoP meeting on ICT for RBF!
Nicolas de Borman is one of the founder of the PBF COP and the director of BlueSquare.org