From November 7th to 11th , 2022, Ylse van der Schoot, the Chief Operations Officer of Cordaid, visited the Cordaid Ethiopia country office for the first time. She is a member of Cordaid’s Board of Directors and is responsible for overseeing all of Cordaid’s programmes, as well as all the operations of the country and cluster office – supporting the accomplishment of Cordaid’s goals on the ground. During her visit to Ethiopia, she got a closer look at the Performance Based Finance (PBF) Health and Education programmes – the flagship programmes of Cordaid in Ethiopia. Along with other Cordaid PBF staff and representatives from the programme’s donor, the Embassy of the Kingdom of the Netherlands in Ethiopia (EKN), she met with government officials from the Ethiopian Federal Ministry of Health (FMoH), and other key health authorities at the district, zonal and regional level from PBF implementation areas. She also met her Ethiopia colleagues and visited some health facilities and schools implementing the PBF project in the Jimma Zone of Oromia region.
Our interview with Ylse revealed her main takeaways and experiences of her trip and the PBF Health programme.
How long have you known about PBF?
I heard about PBF even before I joined Cordaid. I know that it is important approach that works well for systems strengthening. Since being here in Ethiopia however, I have learned so much more. I have met with many different people and stakeholders, such as health authorities at the zonal and regional levels, people from the communities where PBF is being implemented, and staff working in health facilities that are being supported by the PBF programme.
During this visit, what has been your observations and general thoughts on the impact of PBF on Ethiopia’s health system?
It was positive and fantastic to see that so many people in different facilities providing services at various levels – from health posts to health centres, and the primary care hospitals. It is good to see and hear about the improvements from before to after. I also appreciate that we visited the State Secretary of Health, and spoke with the zonal authorities about their offers, as well as looked at data, challenges, and successes.
I think that Ethiopia is unique in that it has different regions. There are awesome collaborations on the regional level, as well as strong ties and supporters on the national level. However, this does not mean that there is yet full national level buy-in for PBF. It is still very much focused on a few regional interventions, but the changes that have occurred thus far are an interesting ambition for the future. If we want to institutionalise and scale up PBF, to further strengthen the Ethiopian health system, to reach and benefit more people, then national level advocacy is needed. Collaboration is needed at all levels to make it work in practice.
What do you think makes the PBF approach unique?
In terms of how Cordaid implements the PBF approach, what makes it unique is the combination of coaching, results-based work, and ownership. Generally, people are motivated to do better when they are rewarded for doing so and are given ownership. In our PBF programme, health facilities get to decide how their earned PBF subsidies are used to improve the facility and overall health service provision. We have seen and heard directly from staff that having this power is very encouraging. They also very much appreciate the hands-on and regular coaching and guidance that they receive from PBF verification officers – which aids them in continuous improvement and meeting their performance goals.
What do you think about the project’s success, and the role Cordaid Ethiopia is playing?
It is amazing!
. I am so proud of all my colleagues here. What we are witnessing is the effort of our Ethiopian staff, both those based in the field and those based at the Addis Ababa office. I sit behind my desk and my computer in the Netherlands and talk to a lot of different people online. But it is so good to meet our colleagues here and see how well-trained, well-organised, committed, and appreciated our professionals are. Our staff in Ethiopia are very professional, and they know what they are doing – evidenced by the amazing outcomes their work. I am so happy to see that. I look forward to returning to the Global Office in the Hague and telling my colleagues there all about what I saw and heard.
What is your hope for PBF as a system Strengthening approach in Ethiopia?
I think it would be fantastic
, to see the PBF approach institutionalised in the Ethiopian health system and perhaps even others, such as education. The evidence shows that the approach works! To make it sustainable, the national government needs to take PBF to the next level and roll it out throughout the entire country.
Any last words?
I am very thankful for everything that was arranged. It is fantastic to be here, and I am proud of everyone. Of course, I did not meet everyone in Ethiopia, but I am happy to have met so many of you, and I wish you all the best.