Lindsay Morgan

Progress made through PBC in Liberia in the post-conflict period is a reason for optimism. Keys to success are strong leadership, good communication among partners, flexible and responsive management. This article highlights the overall design of schemes and lessons learned.

This feature article describes how voucher programs for safe motherhood services and management of STIs in Uganda and Kenya are helping improve health outcomes for the poor. Voucher programs take time and investment to design and administer, but the evidence suggests they can increase access to essential services and enable facilities to be more responsive to patients. This article highlights issues of managing claims, accrediting facilities, fraud and sustainable financing.

Amanda Glassman, the new Director of Global Health Policy at the Center for Global Development, has worked for 20 years on health and social protection policy in developing countries, with a focus on Latin America. Lindsay Morgan interviews her about RBF, stimulating demand for health services in Africa, and the promise of and challenges of CCTs in reaching the poor.

Sudan has some of the worst health indicators in the world. Malnutrition is widespread, vaccination rates are low, and tropical diseases account for a considerable proportion of the total burden of disease. Performance-based contracting is being tried as a means to spur dialogue between NGOs and the government, and sharpen the focus on results as the public health system rebuilds. Will it work?

After decades of brutal civil war, the government of Southern Sudan, donors and NGOs are working to deliver basic services and build, almost from scratch, a public health system. Performance-based contracting is being tried as a means to spur dialogue between NGOs and the government, and sharpen the focus on results. Many believe it is a good idea —in theory— but what about in practice?

Donor countries have committed to major increases in development assistance but doubts remain about its effectiveness. Experts suggest exploring Cash on Delivery Aid (COD Aid), an approach that links aid directly to outcomes. The idea is startlingly simple (and some think risky): donors pay a fixed, incremental sum for verified outcomes and recipient governments decide how to achieve the outcomes and how to spend the reward.

A Community of Practice (CoP) for results-based financing (RBF) was launched in February 2010 during a workshop on RBF in Burundi, the second country in Africa, after Rwanda, to design and implement a nationwide RBF program. Burundi’s RBF scheme provides incentives to health facilities based on quantity and quality indicators and was launched nationwide in April. The CoP members are sharing best practices and knowledge and hoping to create interactions between practitioners, policymakers, and donors.

Launched in April 2010, expectations surrounding PBF in Burundi are rich—and the challenges are many. The government made an ambitious decision: to scale it up across the country, in concert with another major reform—free healthcare for pregnant women and children under the age of five.

A pilot performance-based contracting scheme was started to improve the quality and access to health services at private not-for-profit health facilities. In addition to performance incentives, facilities could decide how to allocate resources, which had a positive impact, but the incentives did not. See the design and implementation issues behind the failure of the incentives. The good news - enormous improvements can be had by granting facilities freedom to choose how to spend their money.