RBF GAVE A GOOD START
2016-03-10

On December 17, 2014, in Bishkek, at the Republican Scientific Medical Library,  the meeting of Technical Group of "Health results based financing" (RBF) took place by participation of representatives of Ministry of Health, Mandatory Health Insurance Fund and partners on development, where the results of the project were represented.

In her interview Klara Oskombaeva, Director of RBF project commented the results of implemented work:

- Main conclusions made on conducted two reviews?

First of all, hospitals are always in sight of ​​attention and under supervision of Ministry of Health and Head medical department interests in their activities. We also showed in comparison, what is needed to improve, and which hospital can do it or not.

For the Ministry of Health, it is important that it can attend hospitals quarterly and evaluate their work, and it has a simple, accessible and understandable for managers assessment tool that covers all aspects of the hospital. For the hospitals themselves it is a good tool, of course, it is a Scorecard, which allows to assess inside and view all aspects of their activities and, most importantly, on clear and simple criteria.

-And what criteria Scorecard includes?

When we talk about sanitary state of hospitals, we are referring to presence of warm, fresh water flow. When talking about neonates in the delivery room, we say that temperature regime should be permanent there, and not just at the time of delivery, when heaters are turned on. This situation should be considered not at the level of physician or the director, but at the level of nurses, i.e. we stimulate to work all employees of the organization. If we are talking about cleanness, then this should be at the level of sanitarian, who maintains order. Each employee should feel responsibility, because certain points will be given to every action. Thus, the process of improving conditions at the hospital involves whole team.

By the way, this is a very good experience when one hospital is visiting another. This is - a spirit of competition, mentoring, sharing of experiences, dialogue, and learning at the same time, solution of some problems, because all of our hospitals have the same problems. Communicating with each other, they try to solve them, and not at the level of seminars and large conferences, but in the working process. Hospitals conduct self-assessment using given tools.

- Are there any specific examples of how and what has changed in the selected hospitals?

Well, for example, small Aidarken General Practitioner Center (GPC) showed good results in the farest Kadamjai rayon. It turns out, that if it is desired, it is possible to create all conditions even in there: to make showers and water, for example, Kara-Suu Hospital made it. Water is being installed in Bazar-Korgon, and they have not only water, but also soap, and towels. These positive changes have occurred in hospitals after their visits to other hospitals, they take examples.

- And which hospital has earned the most points and has already received a payment for it?

Most points, 698, Aidarken GPCs from the second group has earned. In the first group Kochkor TH, Dzhety-Oguz distinguished. According to money payments, they received substantial amount of sum. For example, Ak-Syiskaya Hospital on the results of two surveys earned about 3 million soms. If the best hospitals will receive 2.5 million soms quarterly, it's a good increase in their budget!

- Which resources did hospitals use to improve conditions and gain points?

The most interesting thing is that they did it without money, with their resources. If you point out its shortcomings correctly and show what things the hospital has to do, it can find means, and can do it.

- That is managerial approach, is that?

Usually we train our leaders to some global things. They understand that they need to reduce maternal mortality, but they do not always know the ways of how to achieve. Scorecard - this is a simple tool that shows what and where is necessary to improve: to install water, change temperature, purchase medical equipment. And there is nothing superfluous, only the most important and necessary things! Even reserve of medicines is only that which is needed.

- It turns out, that the RBF project aims to teach our health managers to use resources effectively and efficiently?

Our task is to demonstrate and give them the tools, as well as how to do, and then  stimulate: the first group of hospitals takes financial incentive payments, the second gets moral support. All results of the review are sent to all hospitals. They all can see them.

 

- What are the future plans of RBF project?

Up to now, we have conducted two surveys - the baseline and first planned survey. We are planning a second review. Scheme of reviews is the same, just we will put new aspects each time, i.e. if we see that Quality Committees, which mission is to improve quality of hospitals’ work, do not work, then in future we will try to strengthen work of Quality Committees.

As hospitals have already received the first payment, we will help them how to use them according to the goals that will help improve hospitals’ performance. Thus, the points will increase and earned money.

We plan to hold a series of trainings and workshops. The first year, we have worked on improvement of structure. Ahead we put a goal to solve problem of achievement of qualitative health care. Quality is the knowledge, skills and their practical application by medical workers. This is RBF’s second task. After all, it is no secret that a lot of seminars on effective perinatal care are being conducted, and emergency obstetric care, but health care providers, as result of the survey shows, they are not able to use obtained knowledge in practice. It is necessary to ensure that this technique should be at the subconscious level.

Now we are busy with studying the world experience, because there are a lot of developments about forms of surveys and questionnaires. We were offered, for example, in real-time to carry out a simulation analysis to evaluate skills of medical staff. I think that in the coming 2015, we should devote our work on study of making correct assessment, as well as development of mechanisms. By the end of the coming year, we must already begin to test these tools, and in 2016 to be away from structural aspects. I think during one year, with good management, quarterly reviews and our advice, we will be able to change the structure. The question of quality - is our long-term objective.

Interviewed Elena Bayalinova