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The principal objective of this article is to evaluate whether Performance-based Financing (PBF) is a more effective alternative to input-based financing alone, with focus on HIV and maternal and child health (MCH) services. The secondary objective is to determine the temporal effects of PBF in order to better understand its lifecycle—how long it takes for PBF to take effect and how long this effect lasts. Third, this study examines the relationship between the level of effort for a particular indicator and its responsiveness to PBF. Finally, this study aims to determine whether there were any spill-over effects of PBF on non-incentivized services.

  • This study demonstrates that, in Mozambique, PBF is a superior strategy than standard input-based financing alone for improving MCH, PMTCT and paediatric HIV outcomes.
  • Findings show that PBF not only delivers large increases in health service outputs for many indicators, but that the effect of PBF is generally sustained over time. This study also takes a more robust view of whether PBF is effective by creating a responsiveness index that goes beyond simple statistical significance and accounts for the magnitude and duration of effect.
  • Policymakers in Mozambique should consider scaling-up this program nationally, and potentially expanding to include other public health priorities including malaria.
  • Using an exposure-time model, our study shows that the positive effects of PBF can be observed after six quarters of implementation, and are generally sustained thereafter.
  • This study also takes a more robust view of whether PBF is effective by creating a responsiveness index that accounts for the magnitude and duration of statistically significant impact, an approach we recommend future impact evaluations build from.
  • Policymakers as well as international funding organizations operating in Mozambique should consider scaling-up PBF programs nationally, and potentially expanding to include other public health priorities.
  • Finally, this study applied the same model of PBF in two separate geographies of Mozambique, thus offering insights into the contextual factors that determine effectiveness. While other countries should take note of Mozambique’s results, they should also recognize that context is essential—results on the same indicators varied across regions—so policymakers must attend to their own varied contexts when designing PBF programs.

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Author/s: Yogesh Rajkotia, Omer Zang, Pierre Nguimkeu, Jessica Gergen, Iva Djurovic, Paula Vaz, Franscisco Mbofana, Kebba Jobarteh
Publication ID: https://doi.org/10.1093/heapol/czx106
Countries: Mozambique
Date of Publication: October 2017

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