With ThinkWell support, Haiti’s Ministry of Health (MSPP) strengthened its systems and capacity to receive and coordinate direct government-to-government (G2G) funding, for which it created a Contract and Program Management Unit (CPMU) to serve as a purchaser of health services. The support to the MSPP also prepared them to manage a results-based financing (RBF) mechanism to incentivize better service provision in public facilities.
Efforts to improve Haiti’s health system have frequently been led and executed by international donors and non-governmental organizations (NGOs). One of the longest-standing performance-based contracting mechanisms in health has been funded by USAID through one of its implementing partners, operating through public facilities, but not within the MSPP.
In recent years, international donors have grown supportive of direct G2G funding and emphasized locally owned and led solutions. At the same time, Haiti’s MSPP has grown stronger and is assuming its mandated stewardship role for the well-being of Haiti’s people. USAID and the World Bank simultaneously showed interest in increasing local ownership as well as reforming a primarily input-based public funding model and moving toward an output-based model.
Assessing Capacity and Context
At USAID’s request, ThinkWell assessed the MSPP’s readiness to receive direct G2G funding and to manage an output-based funding model, contracting in health services from providers.
Our approach was to analyze the financial management, planning, and information systems units of the central MSPP, and the financial management and management systems of provincial health offices and service providers. Additionally, ThinkWell analyzed existing contracting out and performance-based financing (PBF) mechanisms in use in Haiti and recommended ways for the MSPP to establish a CPMU.
Building the Contract and Program Management Unit (CPMU)
Following on from the assessment, ThinkWell provided ten months of technical assistance to create the human resource and structural capacity within the MSPP to manage a new RBF mechanism. On behalf of USAID and in close coordination with the World Bank, ThinkWell led an intensive series of meetings with representatives from MSPP, other ministries, donor agencies and NGOs to:
- build consensus around the unit’s mission, function, and design;
- educate participants on the fundamentals of contracting and RBF; and
- facilitate deeper understanding of a USAID and World Bank RBF mechanism, including indicator selection, fee setting, and verification.
ThinkWell worked closely with the MSPP and the World Bank to define a structure for the new contracting unit, in alignment with the unit’s mission, identifying and recruiting staff, designing planning and financial management linkages with other MSPP units and educating public health leaders in the pilot dÃ©partements on their roles within the RBF mechanism.
The potential for G2G by the US government to the Haitian government was the subject of substantial interest from US government parties, including the Global AIDS Coordinator and the USAID Assistant Deputy Administrator for Global Health.
ThinkWell’s work in Haiti resulted in the creation of the CPMU, built the Haitian government’s capacity to directly receive funds, and reformed the financing of public health facilities by the State.
out-of-pocket health expenses spent with private providers