EPOS supported the Ministry of Health of the Republic of Tajikistan in designing and scoping a Result-Based Financing (RBF) Programme that seeks to improve the coverage and quality of primary health services provided to the population. The main focus of the Technical Assistance (TA) was to make available additional financing to participating primary health care facilities when they comply with set performance indicators. EPOS and its partners provided Technical Assistance in the following four areas: Design and implementation of RBF Programme for Primary Health Care. Assessment and development of funds flow mechanism for the RBF program. Design of the management information system. Preparation of the RBF operational manual.
The Consultant Team reviewed the relevant health sector documents, such as policies, overall strategic plans, reform documents, MCH strategy, human resource information, annual HMIS reports etc. In particular, the team studied the World Bank RBF feasibility survey updating the information which was already three-years old. The team verified the information with all stakeholders by conducting a field visit and organising a workshop to discuss the draft design of the RBF programme. During the field visits, the team collected ideas about RBF and potential challenges in the rayon. National stakeholders, such as key programme directors in the MoH, the planning and finance department, as well as key development partners/donors and their technical assistants were likewise interviewed in Dushanbe. The feasibility of using the HMIS was also assessed. The findings were used in identifying advocacy issues and in proposing adaptations to the RBF scheme. All this information has been crucial for the development/revision of the RBF manual, once the design was agreed upon. The Team conducted a mapping of the community social capital in the rayons included in the RBF scheme. This exercise aimed at establishing the capacity of the civil society in the catchment area of the health facilities to be involved in the community verification system. The Consultant facilitated a workshop to discuss the draft design and management arrangements with stakeholders, including the relevant officials from the pilot areas. Once the set-up of the RBF scheme had been agreed, the team, together with the MoH, drafted all the necessary tools, i.e. contracts, fee schedules, verification forms, quality checklists, tools to monitor and analyse data etc. These tools were presented to the Steering Committee and concerned agencies for approval. The RBF scheme is described in an operational manual, detailing out all responsibilities and procedures.