REPUBLIQUE DU CAMEROUN SOUTH WEST REGIONAL FUND WORLD BANK

MINISTRY OF HEALTH FOR HEALTH PROMOTION

FUND HOLDER AGENCY

STANDARD CONTRACT BETWEEN THE FUND HOLDER AGENCY AND THE COMMUNITY BASED
ORGANIZATION (CBO) FOR COUNTER VERIFICATION ACTIVITIES IN THE FRAMEWORK
OF THE PERFORMANCE BASED FINANCING PROJECT IN THE SOUTH WEST REGION

REGION: SOUTH WEST

DISTRICT…………………………………..
NAME OF THE ENTITY: ……………………………………………………………………………………………………………………

PERIOD FROM ………………………………../202….… TO……………………………………/202……. (QUARTER: …….…)

PARTNERSHIP AND COLLABORATION AGREEMENT FOR THE IMPLEMENTATION OF THE PERFORMANCE

BASED FINANCING PROJECT IN THE SOUTH WEST REGION OF CAMEROON
Between

South West Regional Fund for Health Promotion here in referred to as the Contract Development
and Verification Agency (CDVA) represented by
……………………………………………………………………………………………………on the one hand;

And

The Community Based Organization (CBO)………………………………………………………………………………………...,

here in referred to as the “Community Verificator” and represented by
…………………………………………………………………………………………………….., the President on the other hand;

Article 1: Community verification through household visits within the context of Performance
Based Financing

The community/household surveys or verifications are aimed at ensuring or ascertaining that all the
persons or patients or clients declared by the health care providers to have benefited from their
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purchased healthcare services actually exist and effectively did so. That is, these persons were in
contact with the health facility and actually received the indicated services at the said time.

The surveys/verifications also seek to determine the average costs of the services provided by the
health facilities as well as the perceptions of the population on these costs and the quality of health
care and services received.

These surveys/verifications are carried out by the members of the Community Based Organizations
(CBOs) which represent the communities within the catchment areas of the health facilities.

Article 2: Obligations of the Two Parties

2.1. Community Based Organization

The CBO commits to work for the Performance Based Financing (PBF) project in the SW region in
accordance with the terms indicated in this contract.

The CBO undertakes to :

 Administer questionnaires to the patients who used the health facilities of

……………………………………………………………………………………………………………………………………………………..
during the period of ………………………………………………to……………………………………….. as randomly
selected and provided by the contract development and verification agency.
 Provide a team of at least four (4) members to be trained or who have been trained by the
CDVA to this effect with the following qualifications (aptitudes):
 Diplomatic and able to keep confidential information.
 Able to speak the local language where the survey will be implemented (English,
French, pidgin, dialect of the zone, etc);
 Available for at least 15 days per quarter to administer the questionnaire;
 Be able to move easily either on foot or by his/her own means of transport to get to
the households where the patients are found;
 Is interested in community development;
 Of good moral standing ;
 Has good communication skills ;
 Be able to work in a team.
 Draw up a verification calendar and provide to the CDVA on the administering questionnaires.
 Shall evaluate and pay their agents involved in this activity.
 Shall assist and facilitate the technical supervision of the CDVA agents in the field or in their
office when need be.
 Only the names of the CBO agents who interviewed the clients should be written on the
questionnaires and activity report.
 Participate in counter verification of questionnaires when need be;
 The CBO shall participate in counter verification and Monitoring and evaluation of their work at
the end of the quarter at their cost.
 Complete submission of the CBO activity reports, bills, bank attestation, and questionnaires
(filled and unfilled) should be done by CBO within 15 days of execution of the duty.
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 Provide confidentiality report directly to the CDVA Manager on the general observations of
community verification activity and provide specific feedbacks on the reasons for patients not
traced. Also, include feedback on any useful information about the health facility functionality,
from the community and work approach of the community verificator.
 Available for concerns and checks of CBO bills at the district level as well as at the Regional Level
whenever the need arises.
2.2. The contract development and verification agency (CDVA) undertake to

 Draw up the sample of patients to be surveyed (verified) and questionnaire and other
necessary documents to the CBO;
 Train the CBO members (4) on the administration of the Community verification
questionnaire and reporting by providing resource persons and logistics;
 Control the questionnaires returned by the CBO members;
 Pay the sum of Two thousand Five hundred (2,500) FCFA per validated questionnaires
traced by physical contact and one thousand five hundred (1,500) FCFA per validated
questionnaires traced by telephone call to the CBO.
 Participate in regular counter verification and supervision of CBOs in the field;
 Sensitize CBOs and health facilities on the conduct of community verification activity.
 Upon verification/validation by CDVA verificator and eventual evaluation by Ministry of
Public Health (CTN), payments shall be made to the operational Bank account of the CBO.

Article 3: Duration of the Contract

The present contract covers a period of Three (3) Months beginning from
………………………………………… 202.…to ………………………………………………. 202………….

Article 4: Payment modalities

The CDVA shall provide the CBO with questionnaires as follows: -

S/N. Health facilities No of questionnaires

TOTAL

Worth a maximum payment of

………………………………………………………………………………………………………………………………………………………

The CDVA shall pay the due sum to the CBO through bank accounts belonging to the organization.

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Payments shall be done by the CDVA upon the verification and validation of the questionnaires,
activity report and bills and eventual evaluation by the CTN. However, incase payments shall be
delayed the CDVA shall duly inform the CBO as soon as possible.

Article 5: Reasons for the Non-payment, cancellation or non-renewal of the contract

a) Questionnaires not properly filled will not be paid for.
b) Late submission of the questionnaires and report (beyond 15 days of execution of duty)
will lead to the non-payment of the CBO. Beyond 21 days, the contract will be cancelled;
c) Deliberately with-holding accurate feedbacks from the community and the effective cost
appraisal of health facility will lead cancellation of Bill.
d) Filling the names of CBO agents who did not participate the community verification
activity will lead to cancellation of Bill.
e) Clients traced through phone call and reported as physical contact for economic
reasons, the questionnaires will be considered as malpractice and will not be paid for.
f) Fictitious information (fraud, collaborating in fraudulent activities) provided on the
questionnaires will lead to immediate cancellation of the contract and litigation may
be engaged.
g) Breach of confidentiality by any agent of both parties may lead to the suspension of
contract.

Article 6: Conflict Resolution

In the course of the implementation of the PBF project, any discords or differences have to be
resolved amicably. Where a solution cannot be found, the opinion of the immediate hierarchy of the
level at which the issue is found is sought. If a compromise can still not be found, the Ministry of
Health (MOH) will take a final decision to settle the differences.

Done in two (2) copies at …………………………….…………………… On …........./.........../..............…

For the South West Regional Fund for Health Promotion Fund Holder Agency (SWRFHP)

………………………………………………………………………………………………………….

PBF Project Manager SW Region

For the Community Based Organization (CBO)

Name and surname:…………………………………………………………………..

The President of the CBO

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