Some Days Are Better Than Others: Lessons Learned from Uganda’s First Results-Based Financing (RBF) Pilot

This feature story by Lindsay Morgan describes how in 2003, the Government of Uganda launched a pilot performance-based contracting scheme designed to improve the quality of and access to health services at private not-for-profit (PNFP) health facilities. In addition to performance incentives, facilities were given freedom to decide how to allocate resources. The latter innovation had a discernible positive impact on health facility performance, but the former—the incentives—did not. This brief explores the design and implementation issues behind the failure of the incentives and shows that while incentives matter, the success of RBF programs is not inevitable. They require significant investment (of time AND money) and careful design and implementation. The good news, though, is that enormous improvements can be had for free—by granting facilities the ability to choose how to spend their money.