As part of our mandate to gather and disseminate evidence and knowledge from global RBF experiences, RBF Health regularly organizes events, including seminars and capacity building workshops.
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Providing Health in Difficult Contexts: Pre-Pilot PBF Experiences in Adamawa State
Poor health systems are considered to be a major constraint to improving health outcomes. Adamawa State is located in the North-East Region, where the health service performance has been one of the worst in Nigeria (DHS 2013). Its health systems, as in other northern states, has many systemic challenges such as fragmentation and lack of coordination between federal, state and local government, unclear accountability and no incentive for good or poor performance, little resources at the front lines, and weak autonomy at health facilities. Furthermore, since May 2013, the state has been under a “state of emergency” with security threats by insurgency.
Adamawa State started a pre-pilot performance-based financing (PBF) scheme in Fufore Local Government Area (LGA) in December 2011. Over a period of 2 years, despite its “state of emergency” status, the state turned around the health center performance of the pre-pilot LGA. It improved the coverage of critical health services such as institutional delivery, full vaccination and family planning from 2-10% to about 40% (verified operational data). The state fully financed the pre-pilot PBF from its own budget and implemented PBF. Further, it spearheaded the “Primary Health Care under One Roof” initiative and consolidated the fragmented authority into the state (e.g., authority to hire and fire health staff to optimize the workforce). It also made PBF the platform for health service delivery in the state, integrating technical assistance from UNICEF/EU to maximize the potential of the PBF approach.
In this RBF seminar, presenters will highlight the experiences from the Adamawa Performance-based financing (PBF) Pilot, the challenges faced, the early results and how the pilot is leading the way for improved coordination and sustainable health system changes.

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Abdullahi Belel, Chairman, Adamawa State Primary Health Care Development Agency

Abdullahi Belel is currently the Chairman of Adamawa State Primary Health Care Development Agency. He has worked as clinician at Federal then State level and later as a public health physician at the state level before joining the Netherlands Leprosy Relief supporting Leprosy, Tuberculosis and HIV/AIDS control in Nigeria and The Gambia. He also worked as an independent consultant in various capacities for both government and non-governmental organizations mainly in Nigeria.

Shunsuke Mabuchi, Health Specialist, The World Bank

Shunsuke Mabuchi is a Health Specialist at the World Bank. He works for Nigeria, Liberia and Sierra Leone leading the work in result based financing (RBF), polio eradication, health center management, quality of care improvement and private sector engagement. He also developed a World Bank's business plan for scaling up RBF in the next five years. Prior to joining the Bank, Mr. Mabuchi worked for McKinsey and Company as a manager to improve operations and service delivery of various private and public organizations in South Africa, Australia, Japan and Indonesia. He also worked for Japan International Cooperation Agency (JICA) as a project manager and UNDP as a BOP business advisor in Cambodia, Myanmar, Indonesia, Mongolia, Tanzania, Ethiopia and El Salvador.


György Fritsche

György Fritsche is a medical doctor specializing in tropical medicine. For the past twenty years he has been living and working as a practitioner, public health manager, and advisor in Zambia, Senegal, Afghanistan, Kenya, South Sudan, and Rwanda. For the past ten years he has been closely involved in designing, implementing, and scaling up performance-based financing (PBF) programs in Afghanistan, Rwanda, Burundi, Kyrgyzstan, Nigeria, Djibouti, Lesotho, the Democratic Republic of Congo, and the Republic of Congo. Since 2009 Mr. Fritsche has worked for the World Bank as a senior health specialist. He advises colleagues and governments in appropriate design and implementation issues related to results-based financing programs.


Providing Health in Difficult Contexts
Providing Health in Difficult Contexts