Home Grown Incentives in Katete District

Harrison Mkandawire

District Director of Health

Katete District

Katete at a glance

Population: 233,582 (CSO-2000)Health centres: 26

One general hospital:1Trained staff: 86%

Number of CBHCP: 2,462District grant: K406,341.932

MBB District

Why we Introduced Incentives

• Health Care workers paid salaries that are not linked to output or outcome measure

• High maternal mortality ratio

• High infant mortality rate

• More deliveries taking place at home

• Focus was on input or processes

• High CBHCP turn over

Anchorage

• Results based planning

• Results based management

• Participatory Planning

• District Health system strengthening

PPP

• CIDRZ

• CHAMP

• LWF

• CARE INTERNATION

The home grown incentive mechanisms:

• rewarding institutions for actual not promised performance

• linking funding to the quantity of outputs or the quality of outcomes rather than inputs

• using performance indicators that reflect public policy objectives rather than institutional needs

• designing incentives for institutional improvement, not just maintaining status quo

Why Incentives for Health Workers

• Link Incentives to performance

• Hold them accountable for the results

• Change their mindset

• Accelerate the attainment of health related MDGs

Indicators to be attained

• Institutional deliveries

• Fully immunised children

• ITN utilisation

• IPT Coverage

• Pit latrine coverage

• Contraceptive uptake

• PMTCT

Incentives for TBAs

• K100,000 ( Thirty Dollars )

• Chitenje material

• Bicycles

Incentives for clients

Mama kit- those who deliver in the facilityBaby Kit for post-natal- 6 days, 6 wksFood for Ante-natal clients and Under five

clients Food for clients who attend outreach

sessions

Financial incentives for Health workers

• Floating Trophy

• K1,000,000 for the best performing health centre

• K800,000 for the facility for achieving the target

Source of Funds

• 10% community allocation from the district grant

• 4% replacement of the lost user fees

• Child health and Maternal Health allocations

• Community Development Funds

Reorientation of CBHCPs

• Galvanise efforts towards MNCH

• Retrained CBHC

• Use of RDTs at Community level

• Use of Coartem at Community level

• Use of Amoxy at Community level

Other Innovations

• Bicycle Ambulances• Community HFRs• Transport for the Dischargees from the hospital

and the deceased • Solar panels for staff houses• All centres have motorbikes• All centres have HFRs• Detached delivery rooms• Display of imprest allocation to health centres• 100% disbursement of imprest to health centres

Innovations cont….

• Motor bikes for all health centres

• Imprest schedules distributed to Health centres, Health centre chairpersons councillors and Members of parliament

• K300,000 local retention allowance

• Collection of school children for the members of staff in hard to reach areas

Management benefits

• Management latitude

• Innovativeness

• Development of teams cohesion

• Team accountability

Challenge

• Increased attendance in health centres

Sustainability

• Use of the local resources

• PPP- Dunavant Cotton Company

• Participatory planning

Conclusion

• Need to increase the coverage of selected MNCH services to reach the MDG

• Ineffective incentives faced by both providers and households hinder achievements of health outcomes.

THANK YOU FOR YOUR ATTENTION.