Performance-based financing: the same is different

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. Failing to acknowledge the importance of the different
elements of PBF negatively influences the task of practitioners, researchers and policymakers alike.
After making the case for this wider definition, we propose three research pathways (describing,
understanding and framing PBF) and give a short and tentative starting point for future research,
leaving the floor open for more in-depth discussions. From these three vantage points it appears
that when it comes to PBF ‘the same is different’. Notwithstanding the increased complexity due to
the use of the wider definition, progress on these three different research pathways will strongly
improve our knowledge, lead to better adapted PBF programs and create a more nuanced debate
on PBF.