Performance-Based Financing (PBF): Just a donor fad or a catalyst towards comprehensive health-care reform?

This article discusses Performance-Based Financing (PBF) as a means to remedy typical problems faced by the health care systems in low-income countries and accelerate the progress towards achieving the Millennium Development Goals (MDGs). PBF is a form of Results-Based Financing (RBF) that has been implemented on a large scale in several sub-Saharan African countries. The scheme has brought positive results and has been adopted as a national strategy in Rwanda and Burundi.
 
The authors discuss the case of Rwanda in detail, arguing that PBF is a way to address issues such as personnel absenteeism, resource leakage and low rates of utilization of services. It can also improve accountability, as being paid on performance basis forces health care providers to keep accurate and complete records. It also has a positive impact on efficiency of the entire health care system thanks to facilities putting more pressure on their suppliers and policy-makers. Finally, PBF grants service providers more autonomy in managing the resources, so they can tailor their practices to the needs and expectations of local communities. The paper concludes with the acknowledgement of some of the limitations of PBF, such as difficult design processes and the need for the presence of certain prerequisites for the scheme to be successful. Nonetheless, they view those challenges as manageable and see PBF as a catalyst to improve public health systems and health outcomes in low-income countries.
 
 
Bulletin of the World Health Organization
Volume 89, Number 2, February 2011, 81-160