The results-based financing (RBF) model has been piloted and applied in various fields in many countries. In Viet Nam, though the policy “budget management based on performance results” has been included in the Budget Law in 2015, the implementation has not been synchronized. In healthcare, Nghe An is the only province (among six northern central provinces) that was supported by the World Bank to pilot RBF model in the period 2011- 2015. Results from this pilot project have initially shown that RBF did make positive changes in health services at the grassroots level.
Currently, the budget for preventive health services at grassroots levels is allocated per capita. For example, in none-mountainous areas, budget allocation for one person is 246,900 VND per year, and in mountainous area is 333,300 VND per year. There are different senarios in budget allocation for local health station in localities. In some provinces including Quang Tri, allocation of budget are based on actual payment for health care staff plus other expenses (approximately 30 million per year per station). Such way of budget allocation (per capital and human resource in each health station…) reveals a number of inappropriateness such as low effectiveness of human resource, lack of creativeness in organization and renewal and difficult to ensure transparency and accountability…
To introduce and pilot and later replication of the RBF model in Quang Tri, the Center for Development and Integration (CDI) in collaboration with the Quang Tri Department of Health has developed a toolkit to assess communal health station, whose results can be a basis for the RBF model in Quang Tri. This activity is part of the project “Improving the role and effectiveness of grassroots health care to service in order to increase access to quality health services for the poor, women and ethnic minorities” funded by Oxfam within Finance for Development program.
The final toolkit on health care service has been used to pilot on assessment of 6 health stations in Quang Tri, which is done via two rounds of assessment:
- Round 1 (from September 2018): Health stations staff assess health service themselves under RBF criteria. Then health stations will be assessed again by experts from health care staff district health center, provincial Women’s Union as well as independent expert. The involvement of experts aim at analyzing and guiding health stations to define their issues and make their improvement plan. In fact, in Round 1, each criteron in the toolkit is clearly defined so that staff understand how to make assessment themselves. The results of Round 1 is considered input for second round assessment.
- Round 2 (from November 2018): Health stations staff do assessment of health service themselves again under RBF criteria. Then health stations will again be assessed by experts which include community as well. Before the assessment of experts, community groups divide the workload themselves within the group under RBF toolkit, with an emphasis on interviewing service users. Community assessment is the key of Round 2. The results of round 2 will be based to allocate supporting budget for health stations. Supporting budget will be different depending on level of improvement of health stations after 2 rounds of assessment.
- Assessment method combine reviewing records of each health station with field observations and interviews with health service staff. In addition, independent assessment of community groups and direct interviews with local people will be used as well to ensure the objectivity and authentity of the assessment.
After a pilot time in 6 health stations in Quang Tri province, some remarkable results are achieved as follows:
- Develop an assessment toolkit for health stations. The toolkit is considered as a set of criteria to help health stations identify their quality of existing service outstanding issues, priorities and improvement plan.
- Stakeholders expressed interest in health financing, coordinated and supported the RBF pilot implementation in Quang Tri. 2 health centers and 6 health stations who participated in the pilot highly evaluated the RBF criteria and views as well as methods of assessment and the performance-based financial model in health financing.
- Participatory assessment method has made assessment results more objective and honest. Community feedback is also recognized and appreciated by all parties for improvement. In addition, community groups expressed their enthusiasm and confidence in participating health stations assessment.
- Health care service in health stations has been improved positively in terms of quality and professional activities as well as patient satisfaction
However, in order to implement RBF model as a policy solution with an aim to improve health care quality at grassroot level and budget allocation for health care in a more effective and purposeful way, there need to have a longer roadmap for RBF.