Performance-Based Financing Toolkit

Performance-based financing (PBF) approaches have expanded rapidly in lower-and middle income countries, and especially in Africa. The number of countries has grown from three in 2006 to 32 in 2013. PBF schemes are flourishing and cause considerable demand for technical assistance in executing these health reforms in a rational and accountable manner. Currently there is a lack of knowledge among many health reformers of how to implement performance-based financing pilot projects, and scale them up intelligently. In a context of tremendous demand for solid design and implementation experience and given the rapid expansion of results-based financing (RBF) programs, there is an urgent need to build capacity in designing and implementing PBF programs. As yet there has been little attempt to gather the learning from these experiences together in one volume and, moreover, in a form that serves as a guide to implementers. This toolkit answers the most pressing issues related to the supply-side RBF programs of which PBF forms part.

'My delight is that the introduction of the performance-based financing program has brought a total change in Mayo-Ine Health Center with active community involvement, now providing the entire Minimum Package of Activities (MPA), bringing succor to the catchment area population with a significant improvement in the utilization of primary health care services.' --Mrs. Aishatu Kadiri, Community Health Offi cer, In-Charge, of Mayo-Ine HC, Fufore District, Adamawa State, Nigeria

'Before performance-based financing (PBF), we received every day dozens of complaints from clients and patients on poor quality of services and weak staff responsiveness because of chaos that hospital management could not address due to a lack of decision-making power. Thanks to PBF, we can plan and execute actions ourselves with our own resources. Complaints have been reduced a lot, conditions have been improving, and staff is more responsive to the need of the patients.' --Dr. Mohammad Nadar, Director, Provincial Hospital Tirin Kowt, Urozgan, Afghanistan

'Results-based financing is now an important part of the health system toolbox of most African countries. It proves to be a game changing instrument for better governance: getting money to the service delivery frontline including to the most remote areas, fostering autonomy, linking decentralization to performance, giving a new life to the information system, and transforming the wage and incentives environment towards better efficiency and equity of health services.' --Agnes Soucat, Director, Human Development, African Development Bank