Meessen et al

Reviewed by BK

Meessen et al (2011) highlighted the fact that in low income countries there are many problems that jeopardize the achievement of health goals. Despite solutions to these problems, the situation has remained unsatisfactory the past decades. They argued that performance-based financing (PBF) could help to address these structural problems. The reform package of the PBF explained includes the greater accountability, the improved efficiency, and the spill-over effects.

Indeed, PBF could improve the accountability of the providers. A community organization is paid to assess the community satisfaction and the accuracy of data produced by the health facility. However, one could question how far this organization represents the community. The accountability could only happen if the community is empowered.

With regard to efficiency, PBF could improve efficiency by producing more with the same resources.  The fact that the criterion for financing is the real output produced, this strategy creates incentives for more production in order to receive more funds. In addition, transaction costs remain high especially in pilot projects. Apart from Rwanda and Burundi where scaling up of PBF has been achieved, in others African countries, PBF is not yet a national financing policy and donors are funding PBF schemes as a complement to input-financing strategy.

Lastly, the direct transfer of funds to frontline providers is one of the spill-over effects of PBF. Contrary to inputs mechanisms with fixed prospective budget allocations, PBF funds are directly allocated to health facilities based on their health care production. However, to reach this stage, inputs should given to the health facility to make sure that competent staff are available, and equipments are adequate to produce quality health care. The strongest point for PBF is to create the required line management with a clear separation of functions and regular checking if each actor plays its own role correctly.

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