CBEH - Health Financing Programme Draws to an End

The CBEH- Capacity Building for Effective Health financing programme, which started in May 2009 will soon be coming to an end. This programme is the first track of a three year innovative training programme whose objective is to contribute to building strong health systems by strengthening capacities of health workers and institutions to tackle problem areas facing the sector.

The other two tracks in the programme are service delivery which will run in 2010/11 and evidence based decision making, scheduled for 2011/12. The programme was designed by InWEnt and is being offered to participants in Cambodia, Kenya, Tanzania and Vietnam. In Kenya, it is being implemented as a collaborative effort between InWEnt and GTZ.

CBEH Project Status
In May 2009, six Fellows were selected for the programme [Ayub Mwando, Elkana Ong’uti, Edward Rukwaro, Ndiba Wairioko, Ruth Charo and Sam Munga]. The Fellows went through seminars, workshops and a study tour in Germany and the EU headquarters in Belgium. They also held a number of meetings with stakeholders, where they shared their views on health financing and lessons learned during the Europe trip.

The Fellows produced two outputs during the programme: a case study: “Improving Access, Quality and Efficiency of Health Care using Capitation as the Payment Mechanism for Outpatient Services in Kenya”, and a concept paper “Implementing an outpatient service in a social health insurance system – CBEH HF Fellows Perspectives”. This concept paper is in the final stages of compilation and will be presented at an evaluation workshop to be held in Hanoi, Vietnam from 10th to 15th May 2010.

In preparation for the Hanoi workshop, the Fellows met on 24 April 2010 to review the CBEH program. Their reflections are summarized below.

GTZ’s Contribution to CBEH
GTZ has and continues to play a significant role in CBEH. GTZ’s role is outlined below:

• Enabled start up of CBEH programme by funding initial activities and paying for the services of the consultant who acted as the National Team Coordinator for the entire period;
• Guided the selection of Fellows to ensure  the programme got people of the right calibre who would benefit most from the programme;
• Coached and mentored fellows as they worked through the programme;
• Linked them to key stakeholders in the sector; Facilitated opportunities for the Fellows to meet and make presentations to the NHIF Board and the GTZ Health Sector;
• Provided journals, articles, reports and text books to the Fellows.

Achievements

• Fellows have a better grasp and understanding of health financing and broader issues in the health sector. They have also gained the HF vocabulary;
• Fellow’s presentation to the NHIF Board influenced the design of the NHIF Pilot to include capitation. Prior to this presentation, the pilot was going to run on a fee for service basis;
• Fellows are applying the knowledge and skills learnt in their work places.  Elkana is a member of the health financing task force, a member of the NHIF Board and secretary of the newly constituted health financing ICC. In his testimony, CBEH has made his contribution to these bodies more valuable.  He now speaks with confidence when he goes to meetings with the National Economic & Social Council; Ndiba, whose organisation is among those implementing the NHIF pilot, is using the CBEH experience to shape the implementation of the pilot by his organisation. He is also mentoring others in his organisation; Ruth has been asked by the head office in Tunis to help develop a health financing strategy for the African Development Bank. Sam is a member of the HF ICC. All Fellows believe that their capacity in managing projects has increased since starting the programme;
• Acquired a network of contacts locally, regionally and internationally;
• Three Fellows, Ndiba, Ruth and Sam got an opportunity to take the online course on International approaches to Health Financing. This augmented their theoretical knowledge in health financing.

Best Practice

• Inter-agency cooperation: When the programme started, InWEnt did not have an office in Kenya. GTZ supported the start of the programme by providing a consultant and advancing funds to cover planning activities. GTZ used its contacts, connections and position as chair of development partners in health in Kenya to facilitate the activities of CBEH fellows;
• Selection of participants, including those from the public sector was done in a competitive manner. A total of 98 applications were received. CBEH picked the best 6. Result was the programme recruited high calibre participants in senior management positions;
• Equal representation of public and private sectors: The 2009/10 programme had three fellows from the private sector and three fellows from the public sector;
• The capacity building was customized to address issues identified through focus group discussions involving key stakeholders and subject experts;
• GTZ staff and consultants provided mentorship to the Fellows by reviewing case study, provision of reading resources (articles and books). KfW staff also reviewed case study. GTZ facilitated Fellows meeting with senior managers at the GTZ HQ in Eschborn and interaction with GTZ Health Financing experts during the GTZ Health Financing Social & Health Protection Sub group meeting in February 2010;
• GTZ created public awareness of the CBEH programme by advertising the Fellowship positions in the press, printing posters and posting on the weblog;
• Efforts have been made to disseminate the work of the Fellows as they go through the programme. This has been done by posting updates on GTZ weblog, holding a stakeholder’s meeting and making presentations to the NHIF Board and GTZ.

A low point in the programme was the demise of Ayub Mwando who sadly passed away in November 2009.

In summary, the Fellows have had a successful, practical programme that has made a difference in their work places. To quote Ayub “Many programmes claim to be build capacity, but they are nonsense capacity building. CBEH is a true capacity building programme.”

Next Steps

The fellows will hold a knowledge sharing forum after they return from Hanoi. The forum will be convened in collaboration with the newly established Health Financing Inter Agency Coordinating Committee (HF ICC). During this forum, the Fellows will share lessons learned from the training, seminars and study tours as well as disseminate the case study and concept paper developed during the programme. The actual dates of the knowledge sharing forum will be communicated later after consultations have been held with the chair of the HF ICC
All Fellows are committed to continuing being engaged with health financing issues even after the end of the CBEH programme. Elkana and Sam are already members of the HF ICC; Ruth by virtue of working for a development partner sits in a number key meetings governing structures in the health sector as well as being a member of the Development Partners in Health. She will engage in health financing issues at this level.  Ndiba and Rukwaro see the HF ICC as a possible forum for continuous engagement. Fellows will be meeting after the Hanoi Workshop to concretize their ideas on how they will maintain the lifelong learning experience post CBEH

Next Steps
The fellows will hold a knowledge sharing forum after they return from Hanoi. The forum will be convened in collaboration with the newly established Health Financing Inter Agency Coordinating Committee (HF ICC). During this forum, the Fellows will share lessons learned from the training, seminars and study tours as well as disseminate the case study and concept paper developed during the programme. The actual dates of the knowledge sharing forum will be communicated later after consultations have been held with the chair of the HF ICC
All Fellows are committed to continuing with engaging with health financing issues even after the end of the CBEH programme. Elkana and Sam are already members of the HF ICC; Ruth by virtue of working for a development partner sits in a number of key meetings, governing structures in the health sector as well as being a member of the Development Partners in Health. She will engage in health financing issues at this level.  Ndiba and Rukwaro see the HF ICC as a possible forum for continuous engagement. Fellows will be meeting after the Hanoi Workshop to concretise their ideas on how they will maintain the lifelong learning experience post CBEH.

This article was authored by Maureen Nafula, GTZ Consultant