Learning Lessons on Implementing Performance-Based Financing, from a Multi-Country Evaluation

This synthesis report explores the lessons learned on design, implementation and effects of financial incentives in the form of Performance Based Financing (PBF) in the health sector, as supported in Sub–Saharan Africa by the two Dutch NGO’s Cordaid and HealthNet TPO. Towards this aim a multi-country study was undertaken in 2008, led by the Royal Tropical Institute of the Netherlands (KIT) in collaboration with World Health Organization (WHO) Geneva and the implementing agencies in DRC, Burundi, Tanzania and Zambia. Rwanda was also visited to study scaling-up from pilot projects to a national program.

The report presents a meta-analysis of the results in areas such as enhanced health worker motivation and its contribution to increased health service productivity and quality of health care. Some key findings show the potential of PBF as a health financing approach to achieve better results in the health sector while also pointing to institutional dimensions and organizational processes that require further improvement, such as the role of the local fund holder or the autonomy of health providers. In view of the fact that the study was a formative evaluation, some of the findings are not altogether conclusive but map out areas which require further research.