Over the last 15 years, a growing number of low- and middle-income countries (LMICs) have adopted results-based financing (RBF) approaches for their health sectors. This special issue presents key findings from the research program “Taking Results-Based Financing from Scheme to System.” The issue includes four case studies on RBF in LMICs and three cross-cutting articles—one on reframing RBF and two on scaling RBF up from projects and schemes to its integration into national health systems.
RBF consists of purchasing mechanisms that link payments (to either producers or consumers) to process or output measures that serve as indicators of, or as proxies for, improved health outcomes. These measures may be either qualitative or quantitative. RBF schemes have been implemented as standalone pilot projects in various settings, with accompanying research mainly focused on measuring the impact of pilot interventions. The Health Results Innovation Trust Fund based at the World Bank has been a key driving force in this endeavor.
Moving from traditional input-based payment systems to output-based payment systems has been proposed as a potential entry point for improving health system performance and enabling broader health system transformation. Output-based systems include RBF and performance-based financing (PBF), a subset of RBF defined as “fee-for-service payment to providers conditional on quality.”
Despite the potential for RBF to have sector-wide impact, relatively little attention has been paid to understanding how RBF approaches have been implemented and rolled out or to their contribution to strengthening health systems. A few noteworthy exceptions exist. This special issue seeks to help fill this gap.