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Workshops for COGEs in Gicumbi

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Created on 28 November 2006 Published Date
Written by Gyuri Fritsche Hits: 2365

Management Sciences for Health, in collaboration with the Gicumbi District Health Authorities, the Byumba Hospital Director and HealthNet International TPO, organized two workshops for the Comite de Gestion (COGE) in Gicumbi District.

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These workshops, which took place between 28 Nov and 1 Dec 06 and lasted two days each, were meant to assist the COGEs to get a better understanding of their roles in managing performance based financing at the health center level and to help the COGEs to start developing so-called 'advanced strategies' to improve the performance - and hence the population impact- of performance based financing in Gicumbi District. 

Frequently, one refers to the 'black box' of managerial entrepreneurial-ship which, triggered by the incentives of performance based financing, will find new and innovative ways of improving the performance of health services. However, when scrutinizing this 'black box' closer, this box is not that black at all; services need labor, investment and equipment in order to improve the quantity and quality of services that are produced. Experience from PBF pilot schemes in Rwanda, from the former Cyangugu model, has taught us that assisting health center management committees in developing 'advanced strategies' bears fruit. Some health centers rapidly develop successful strategies to increase services such as family planning, vaccinations, institutional deliveries, referrals and so on, whilst others do not develop such strategies, or develop these at a much slower space. Exchanging experience between health providers shows that successful strategies are eagerly copied by others. 

The COGEs are new institutional structures, superimposed on the pre-existing health center management committees, and have been specifically introduced as an important aspect of the new national PBF model. The COGEs were an aspect of the former Butare PBF model. They consist of the President, the vice-President, the treasurer – three non-health center staff- the head of clinic and a second staff member of the health center. In fact, they are like an executive committee, or daily committee, of the existing health center management committee. However, the COGEs have an important role in managing the distribution of funds earned through PBF by the health center, and are instrumental in following the performance of individual health workers employed by the health center.

The President of the COGE (who is also the President of the existing health center management committee) signs the performance contracts ("Contrats d’Achat") with the Government (who purchases the basic package of health indicators) and other donors (such as MSH or the WB/MAP who purchase HIV/AIDS service products). The COGE, on their turn, sign ‘motivation contracts’ with individual health workers. These ‘motivation contracts’ ("Contrats de Motivation") restate the job description of the individual health workers, and indicate which ‘part’ of the budget allocated to individual performance bonuses, the health worker is entitled to, when performing satisfactorily. These ‘motivation contracts’ are a powerful tool for the COGEs to reward individual health worker performance. The ‘parts’ are determined locally, i.e. by the COGEs.

The COGEs can also decide, within certain limits stipulated by the district level PBF steering committee ("Comite de Pilotage"), which % of the income earned through PBF to allocate to bonuses for staff, and which percentage to other non-salary related recurrent costs or investments. A standard guideline frequently used by COGEs stipulate a 80%-20% division; 80% for staff bonuses and 20% to other expenses.

These Gicumbi workshops are a first attempt to assist the COGEs in developing their advanced strategies. A standard two-day workshop methodology has been designed, and will be tested in Gicumbi. When successful, such workshops will be replicated in other districts.

The main purposes of these workshops, which use a highly interactive and participatory approach, are (i) to let COGEs reflect on their roles and responsibilities, (ii) introduce COGEs to advanced strategies and (iii) to present the results of the PBF results for the previous quarter.

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