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The early phases of the HRITF Learning Strategy were concerned with initiating evaluations (including producing tools that would aid in developing evaluations) and learning from the early experiences of implementing RBF programs across its vast portfolio. To support that effort, the HRITF has developed multiple toolkits which have been used by thousands. A rich array of learning has been generated from implementation, particularly through in-country studies and cross-country analyses and topical learning.

With growing interest in the diffusion of policy innovations across countries, this study explores how the features of performance-based financing “diffusion entrepreneurs” and their actions affect the outcomes of diffusion processes.

Our Impact Evaluation Toolkit helps practitioners design and implement impact evaluations, with a focus on Results-Based Financing in maternal and child health programs. The Toolkit consists of 1) guidelines for best practices and 2) tools to implement guideline recommendations such as:

  • terms of reference for team members/survey firms
  • maternal and child health indicators of interest
  • research protocols
  • questionnaires
  • training manuals and curricula
  • fieldwork supervision materials

Performance-based financing (PBF) schemes have been expanding rapidly across low and middle income countries in the past decade, with considerable external financing from multilateral, bilateral and global health initiatives. Many of these countries have been fragile and conflict-affected (FCAS), but while the influence of context is acknowledged to be important to the operation of PBF, there has been little examination of how it affects adoption and implementation of PBF.

The RBF e-learning course has been modified to adapt to the evolving needs of practitioners wanting to know more about RBF. It is now a widely accessible self-paced e-learning course, rather an annual facilitated one.  Strengthen your knowledge: join the course on Results-Based Financing!

The article in the British Medical Journal of Global Health asserts that performance-based financing is a donor fad. The paper questions the mainstream view that PBF is an effective, efficient and equitable approach to improving the performance of health systems. The essay concludes with a series of exhortations to recipient countries, bilateral and multilateral donors, recipient countries and donors, and independent researchers.

This report reviewed the cost-effectiveness of key health systems strengthening intentions, which includes results-based financing (RBF), voucher schemes, health insurance, personnel training, community mobilization, etc., with a total of 24 articles included in the review. Specifically on RBF, this report identified three studies on cost-effectiveness of the RBF programs, and the results showed that RBF was among the cost-effective interventions in addressing maternal and child health services.

In these two videos, Mr. Jean Benoit Falisse, a lecturer from the University of Edinburgh, provides an overview of Community Results-Based Financing (cRBF) country cases, key discussion points and challenges faced by community actors.

Introduction to cRBF

This commentary argues that it is crucial to pay greater attention to the “forest”—that is, overall health system reforms and how provider payment arrangements interact with these to influence health outcomes, as opposed to looking almost solely and more narrowly at the “trees”—that is, the details and impact of a P4P mechanism divorced from the underlying health system. P4P is a category of strategic purchasing, the effectiveness of which depends critically on its connections with the wider environment of purchaser–provider relations.

Although it is increasingly acknowledged within the Performance-Based Financing (PBF) research community that PBF is more than just payments based on outputs verified for quality, this narrow definition of PBF is still very present in many studies and evaluations. This leads to missed opportunities, misunderstandings and an unhelpful debate. Therefore, we reinforce the claim that PBF should be viewed as a reform package focused on targeted services with many different aspects that go beyond the health worker level.

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