PERFORMANCE BASED FINANCING

SUMMARY

Background: Performance-based financing (PBF), often referred to as pay-for-performance (P4P) or results-based financing (RBF), refers to payment to a government, organization, or individual conditioned on taking measurable actions toward or achieving desired goals[1]. Some countries use the term performance-based financing (Cameroun, DRC, CAR, and Nigeria), other countries use the name result-based financing (Zambia, Zimbabwe, Guinea), while the WHO prefers the term strategic purchasing. Basically, the name is not the issue but it is the definition and its underlying best practices that matter.

While PBF is mostly utilized in low- and lower-middle-income countries, the concept of ‘Performance Systems’ is also applied in high-income countries. The term PBF was first used in Rwanda in 2005 and has become a term with a formal definition consisting of a number of best practices and instruments. Performance based financing (PBF) schemes aim to improve health service delivery by providing bonuses to service providers (usually facilities, but often with a portion paid to individual staff) based on verified quantity of outputs produced, modified by quality indicators.
Objectives: To review literature on performance based financing.
Methods: A descriptive qualitative study design was used where sources of information pertaining to PBF were gotten from data bases (PubMed, google scholar, google, WHO, and Plos one). Articles were screened and selected based on titles, abstract, and full content.
Results: A total of 20 articles were selected for the work.
Keywords: PBF, RBF, and P4P.

CHAPTER ONE
INTRODUCTION
1.1 BACKGROUND

Performance-based financing (PBF), often referred to as pay-for-performance (P4P) or results-based financing (RBF), refers to payment to a government, organization, or individual conditioned on taking measurable actions toward or achieving desired goals. With support from a range of donors, including The U.S. Agency for International Development (USAID), many low- and middle-income countries have used PBF in an effort to improve the quality, availability, and uptake of health services[1]. Performance based financing (PBF) schemes aim to improve health service delivery by providing bonuses to service providers (usually facilities, but often with a portion paid to individual staff) based on verified quantity of outputs produced, modified by quality indicators[2].

Such programmes have been increasingly implemented across low and middle income countries in the past decade, focused on maternal and child health services, with considerable external financing from multilateral, bilateral and global health initiatives [3]. The initial rationale was to align provider incentives with public policy objectives, especially linked to the Millennium Development Goals-boosting uptake of services such as supervised deliveries, antenatal care and immunisation [4].
More recently, focus has shifted to the need for greater focus on quality of care, as increased utilisation was not reflected in equivalent health gains[5] and also on how PBF might be catalytic of wider health system changes[6–8].

Over the past 10 to 15 years, results-based financing (RBF) has gained increased prominence in global health has attracted attention as a means of achieving specific health objectives more effectively in low-income countries and fragile states[7].
Numerous sub-Saharan African countries have experimented with performance-based financing (PBF) with the goal of improving health system performance. To date, few articles have examined the implementation of this type of complex intervention in Francophone West Africa.
PBF has been widely adopted in low- and middle-income countries over the past two decades, especially in sub-Saharan Africa[2,3,9].

This trend has been attributed in large part to advocacy by international agencies and nongovernmental organizations (NGOs)[10,11]. In sub-Saharan Africa between 2006 and 2017, the number of countries implementing PBF increased from three to 32 (out of 46), accounting for more than 2 billion USD in expenditure with the objective of reforming their health system[12].

In 2008, with World Bank funding, the government of Cameroon launched PBF in 26 health districts in 4 of its 10 regions (Littoral, Northwest, Southwest and East), covering a total population of 3 million inhabitants. Alongside the implementation of the project, the World Bank conducted an impact evaluation (IE) in three out of the four regions (East, Northwest and Southwest)[13]. Furthermore, in 2009, the Ministry of Public Health in Cameroon, working in partnership with the World Bank, funded the Cameroon Health Sector Support Investment Project. The five-year US$25 million initiative was designed to support the provision of key maternal and child health services through performance-based financing.

In 2014, additional financing of US$40 million through the Health Results Innovation Trust Fund was allocated to support the introduction of PBF in the three northern regions of the country, which have the nation’s poorest health outcomes[14]. Indeed, for instance, the randomised controlled trial of PBF in Cameroon showed that, for most of the positive outcomes, there was no statistically significant difference between health facilities with the standard PBF package and a control group receiving all elements of PBF except the direct link between individual facility performance and additional financing[15].
However, while there is a growing literature on implementation issues and effects on outputs, there has been relatively little focus on interactions between PBF and health systems and how these should be studied remains very limited, particularly in developing countries.
1.2 Significance of the study