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La conférence sur le climat de Paris de 2015 (COP 21) devrait nous aider à planifier des interventions concrètes pour améliorer l'environnement.


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There are three categories in term of periods the child mortality reductions were high (low and middle income countries). The countries selected are the ones conducted the Demographic Health Survey (DHS) and the Multi-Indicator Cluster Survey (MICS).

The category 1 concerns countries that reduced much the child mortality between 1990 and 2000 (red ring). There are: Madagascar, Malawi, Bangladesh, Indonesia, El Salvador and Guatemala.

The category 2 concerns countries that reduced much the child mortality between 2000 and 2010 (yellow ring). There are: Burkina Faso, Kenya, Mali, Niger, Nigeria, Rwanda, Senegal, Tanzania and Uganda.

The category 3 concerns countries that reduced equally the child mortality between 1990-2000 and 2000-2010 (blue box). There are: Namibia, Philippines and Dominican Republic.

Which lessons can we take from these data? (i) We need to recognize that there are good practices in reducing the child mortality in a country. The health systems of the countries should be analyzed to identify what was possible to reduce the child mortality before looking outside. The outside practices require some adjustment and some times are not possible to establish in another country; (ii) The cross analysis of multiple countries may identify global good practices in reducing importantly the child mortality.

The case-by-case deeper analysis of the causes related to the high reduction of child mortality in a specific period of time, will help in the post millennium agenda for much reducing child mortality.

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The performance based financing is defined as financial incentives to motivate the production of more quantity of services and to comply or adhere to quality standards. There are different definitions per the problems to solve and the objectives to achieve. The names are many: PBF (Performance Based Financing), RBF (Results Based Financing), P4P (Pay for Performance), PBC (Performance Based Contracting), PIP (Practice Incentives Program), QOF (Quality and Outcomes Framework), etc. Why financing health service delivery per performance, results, outputs, and outcomes; whatever you call it? There are two main reasons: (i) the current financing system is inputs based. Inputs are equipment, drugs and consumables, salaries, etc.

In real situations, it is difficult to have all items together to expect results. You can have laboratory equipment and lack reagents or technicians. It’s why the investments done in health sector don’t produce expected results. It is “value of money issue”.

When you agree with the hospital or the clinic to achieve measurable results like number of antenatal care services or vaccinations, if there are results, you will pay; (ii) the other reason is because the health service delivery is done by a team of staff; unfortunately, the payment of the health personnel is individual based. Many organizations, especially the governments (main owners of health care facilities) have no customize remuneration systems for the health personnel. They use the traditional salary and benefits system.

For example,

to complete properly a surgery service, a surgeon and anesthetist can be motivated, but the technician for material sterilization or the assistant nurse not.

Meaning that to obtain the maximum of return in financing health service delivery, it requires you attach the financing to the expected result and give flexibility to the providers for having required inputs and put in places the best procedures. Financing health results requires an engine. The engine is somehow more complex as new performing engines. PBF is not a simple purchase of services, as it requires technical judgment of the products when buying. Usually the provider has or pretends to be the one who has the technical skills. It’s why qualified and independent evaluation is to be done to avoiding the conflict of interests of the both sides (purchaser and provider). What makes the PBF scheme much complex is the fact that it is mainly used by the public system, with many layers (ministry of finances, ministry of health, local government, project management unit, etc.). In summary, for ensuring the PBF scheme will work well, a well design system is key. This article summaries proposed key functions that can facilitate proper operating the performance based financing scheme.

The full article with the operational functions is at the "Medical Publication Marketplace"

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According to Unicef, “17,000 children die every day, mostly from preventable or treatable causes”.