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Performance-based financing: from pilot to system

A series of articles on understanding what enables or hinders the transition of performance-based financing initiatives to being fully integrated into national health systems

In low-and middle-income countries (LMICs) approximately 400 million people still lack access to adequate healthcare. One way to combat this and improve the efficiency of the health system is Performance-Based Financing (PBF) - a method where a cash payment transfer is made to a health facility as an incentive to improve the quality and availability of a health service. Payment is made based on whether the service was delivered and used according to prearranged criteria.

Since 2000, professor Bruno Meessen (Department of Public Health) and other ITM colleagues have played a pioneering role in the design, development and study of this health sector reform strategy. Today, more than 30 LMICs, particularly in sub-Saharan Africa are implementing PBF projects; a few like Rwanda or Burundi have scaled-up the strategy as a national policy. There is strong evidence that the strategy helps those countries to accelerate progress towards the Sustainable Development Goals.

So far, PBF programmes have largely been studied as stand-alone programmes, and that research has not contributed to the understanding of why they succeeded or failed as health system reforms.

To address this knowledge gap, the Alliance for Health Policy & Systems Research, the World Health Organization, the Institute of Tropical Medicine and 11 country partners conducted research in 11 countries to understand what enables or hinders the transition of PBF initiatives from pilot projects to being fully integrated into national health systems. The results appeared in the Journal Health Systems and Reform, in a special issue entitled "Taking Results-Based Financing from Scheme to System" that contains four country case studies, two cross-country analyses and two commentaries. The research findings provide very practical knowledge for the many countries engaged in scaling up their PBF interventions. The journal issue also provides guidance on how to align PBF reforms with the overall goal of universal health coverage. Eventually, it is a rich source of learning for all actors and countries struggling with scale-up of health interventions in global health.

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