The document summarizes a study that introduced a performance-based financing model at two health facilities in Port Harcourt, Rivers State, Nigeria. The facilities were previously supported by Shell Petroleum Development Company. 20 months after introducing PBF, which was self-funded unlike national pilot programs, the facilities showed 75% improvement in quality of care. Documentation and several health indicators like vaccination and testing rates increased substantially. The study concludes that PBF can increase utilization, quality, and sustainability when self-funded. It recommends encouraging self-funding PBF models in the Nigerian health sector.

1. Improving quality of care through Performance Based Financing in two shell-supported
health facilities in Port-harcourt, Rivers State : The Self-funding Model
Introduction
Performance based financing is an approach of health
financing that focuses on output and essentially on
outcomes. It’s a reward based system that affects health
care in two ways: motivating providers to put more effort in
specified activities and providing resources needed to
finance the delivery of these services1
Introduced into Nigeria in 2013, with Pilot programs
conducted in three states , which were externally funded.2.
The Shell Petroleum Development Company (SPDC) in
partnership with the Shell IA cluster /Rumuokwurusi
Communities in ObioAkpo LGA and the Rivers State
Government support Community-Based Health Insurance
Scheme (CBHIS) Programme in Rivers State.
In order to improve community health facility utilization and
boost quality health service and performance of the
insurance scheme, in March 2014, a pilot PBF programme
was introduced to two Shell support facilities- Obio Cottage
Hospital (OCH) and Rumuokwurusi Primary Health Center
(RPHC) in partnership with the State and the communities.
Unlike the National pilot programs which is externally
funded, this pilot is self funded.
Results
20 months post-implementation both facilities had 75%
improvement in the general quality of healthcare provided.
Documentation also improved: increase in the quantity
results e.g. number of completely vaccinated children
increased by 114% (on average) and VCT/PMTCT/HCT
Testing increased by 3144% (on average).
Fajola A.1
, Uduma C.1
, Ogbimi R.1
Mosuro O.1
, Usman R.2
, Onwuchekwa J. 3
Aguwa E4
1.Community Health, Shell Petroleum Development Company , Nigeria
2.Obio Cottage Hospital, Rumuobiakani, Rivers State
3.Rumuokwurusi Model Primary Health Centre, Rivers State
4.Department of Community Medicine, University of Nigeria Nsukka
Aim
Improve health outcomes of patient;
Increase administrative performance of the CBHIS
Increase access to and coverage of health care
services
Increase the utilization of health services and
Increase the health facility staff performance for
improved quality services
Materials and Method
It was a before and after study carried out 2 Shell-
supported facilities – Obio Cottage Hospital (OCH) and
Rumuokwurusi Model Primary Health Centre (RMPHC) in
Rivers State
Performance was assessed using quality and quantity
indicators adapted from the Nigerian State Health
Intervention Project (NSHIP) PBF toolkit 2014 version
The OCH Foundation board of Trustees (BOT) under the
Performance-based Financing (PBF) scheme were the
purchasers of the services offered in the two facilities
The two facilities agreed with the BOT for a fixed price for
each indicator
Assessment was done quarterly for qualitative and monthly
for quantitative indicators
Baseline assessment was conducted in 2014 and a post
assessment was conducted 20 months after
The health facilities were paid according to the quantity of
indicators it produced but the final payment took into account
the quality score obtained by the health facility during the
Quarterly Quality Supervision.
Conclusion
Performance based financing increases health facility
utilization and quality of health care more so when it is
sustainable through a self-funding model
Recommendation
Performance based financing: Self-funding Model should
be encouraged for replication and scalability in the Nigerian
Health Sector
Acknowledgements
Obio Cottage Hospital, Rumubiakani Rivers State;
Rumuokwurusi Model Primary Health Centre, Rivers State;
Obio/Akpor LGA;
Management Sciences for Health
Graph 3: Quality result over the quarters for both facilities
in the last 20 months
Graph 2: A Spider web graph of the impact of PBF on the quality of services
after 20 months of implementation
Table 1: Results of some quantity indicators in both facilities
PBF Quantity
Indicators
March 2014
Average/month
Dec 2015
Average/month
Percentage
Increase
Normal
Institutional
Deliveries 54 73 35%
Minor
Surgeries 18 31 72%
Completely
Vaccinated
Children 157 333 112%
VCT/PMTCT/P
IT Test 9 292 3144%
References
1. Kantengwa K., K. T. (2014, February). Result Based
Financing: Concepts and Typology. Port-Harcourt,
Rivers State, Nigeria.
2. Fritsche, G. B., Robert, S., & Bruno, M. (2014).
Performance Based Financing Toolkit. Washington, D.C:
The World Bank.
3. Rusa, L., Schneidman, M., Fritsche, G., & Laurent, M.
(n.d.). Center for Global Development. Retrieved March
1, 2016, from Center for Global Development:
http://www.cgdev.org/doc/books/PBI/10_CGD_Eichler_Levine-Ch10.pdf
Picture1: Presentation of Register at the beginning of PBF
Picture2: Presentation of Register 20 months post PBF
Graph 1:A spider web graph of the baseline quality assessment
Abstract Code No. 084