Photo credit: World Bank/ Armine Grigoryan
PROJECT RATIONALE
During the last decade, improving efficiency featured as a corner stone of Armenia's health reforms, endeavoring to generate significant efficiency and productivity gains to strengthen primary health care and optimize hospital care. Despite important structural and organizational reforms, Armenia’s health care system is nevertheless still struggling to catch up with the epidemiological changes experienced in recent years. Today, as many other low – and low-middle income countries, Armenia faces the dual challenge of the unfinished Millennium Development Goals (MDG) agenda and a record increase in Non- Communicable Diseases (NCDs).
RBF AT A GLANCE
RBF Payments
Under the Disease Prevention and Control Project, the State Health Agency (SHA) of the Ministry of Health (MOH) of the Republic of Armenia purchases predefined MCH and NCD services from primary health facilities located in Yerevan and in the regions (i.e. Marzes). Once these services have been verifiably delivered, PBF payments are disbursed on a semi-annual basis by the Health Project Implementation Unit (HPIU). These payments are typically used to motivate medical personnel, stimulate administrative staff, and support operational costs at facility level.
At all levels, the implementation of PBF activities is regulated by the Ministry of Health which ensures compliance with PBF principles and objectives as well as alignment with national health promotion norms and guidelines at central, provincial and operational levels.
VERIFICATION
The RBF verification function is co-led by the HPIU and a Working Group created with the SHA. These two entities jointly assess the quantity of services provided (a) by comparing reported PBF performance with data contained in the online Health management Information System (HMIS); (b) by carrying out site visits and reviewing facility records and (c) by implementing patient surveys. Ensuing reports are subsequently validated by the MOH as well as by the World Bank. These reports are also used to identify at-risk health facilities which will be examined by the SHA as well as by the State Health Inspectorate of MOH Staff (SHI). In parallel, to further measure performance and ensure compliance with project requirements, an annual external verification/audit is administered by an independent firm on a random sample of facilities.
IMPLEMENTATION
Status and Achievements – Fiscal Year 2016
A PBF dedicated webpage has been developed and launched: it provides regular performance reports for health facilities as well as for the wider public.
The modalities of the RBF verification function have been revised: (a) the frequency of the verification of quantity was increased to quarterly verifications; (b) quality, quantity and patient satisfaction measures are being strengthened; and (c) reporting accuracy is being prioritized.
EVALUATION AT A GLANCE
The Disease Prevention and Control project was designed to include an enhanced program assessment – rather than an impact evaluation. Nevertheless, in an effort to strengthen the project’s emphasis on the quality of care and improve its accountability to the community, the project designed and tested a new patient feedback mechanism: the use of Short Message System (SMS) surveys and phone call interviews (CATI). A pilot impact evaluation was recently completed to test and improve survey tools. Results motivated the adoption of the CATI as a future impact evaluation tool.