Performance-Based Financing in the Health Sector in Cameroon: May Results Be Your Quest and May Change Be Your Result

Emmanuel Maina Djoulde's picture
March 9, 2015

As President of the Steering Committee for the Cameroon Health Sector Support Investment Project, I was pleasantly surprised by the innovative character of the Performance-Based Financing (PBF) approach; and of its transformative potential.

Believe me, establishing PBF requires boldness from all actors!

Indeed, performance-based financing rapidly demonstrated its spectacular capacity to drive profound and systemic change in an environment long ruined by the endemic weaknesses of the institutional mechanisms of health care service delivery. Introduced in a context shrouded in skepticism in which usage and practices did not value results, performance-based financing proved to be more than a pilot experience; it is a real vector of change and a driver of results.

In a methodical manner, it first helped us better understand and analyze the health sector in its catchment area. It then provided unprecedented results thanks to the quick and strong engagement of all actors. This change can be observed in the rapid, and often spectacular, improvements made on incentivized indicators. In many health centers and hospitals we’ve seen remarkable improvements in the utilization of key maternal and child health services, along with an average increase of 60 percent in the quality of services and an increase of 30 percent in patient satisfaction. These improvements have been driven by PBF’s capacity to devise local as well as pragmatic solutions to address the structural problems of the health system, which the central level had difficulties resolving. These include:

  • Continuous supply of medical drugs,
  • Human resource management, and
  • Support to destitute populations as well as to people with poor access to healthcare, etc.

Having reached a turning point in its development, Performance-Based Financing in Cameroon has not only proven itself to be relevant but it has also demonstrated its worth in the context of a health sector which, today more than ever, has to accelerate results.

With these results, very promising prospects are emerging within the context of our partnership with the World Bank and with other technical and financial partners. This year, the results of an impact evaluation of PBF will be made public; full ownership of the approach will be effective once the technical capacity building of local structures, carried out by international NGOs, has been completed; and the project will be extended from the current four southern regions to three additional regions in the north, which are the poorest in the country. A Community PBF component will be introduced to better respond to the low levels of health service utilization that prevail in these new regions. While the challenges remain considerable, this agenda contributes to the development of a plan for the scaling up of PBF to the entire country.


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