Performance-Based Financing Toolkit

Abstract

This work is a product of the staff of The World Bank with external contributions. Note that The World Bank does not necessarily own each component of the content included in the work. The World Bank therefore does not warrant that the use of the content contained in the work will not infringe on the rights of third parties. The risk of claims resulting from such infringement rests solely with you.The findings, interpretations, and conclusions expressed in this work do not necessarily reflect the views of The World Bank, its Board of Executive Directors, or the governments they represent. The World Bank does not guarantee the accuracy of the data included in this work. The boundaries, colors, denominations, and other information shown on any map in this work do not imply any judgment on the part of The World Bank concerning the legal status of any territory or the endorsement or acceptance of such boundaries.Nothing herein shall constitute or be considered to be a limitation upon or waiver of the privileges and immunities of The World Bank, all of which are specifically reserved.

Local stakeholders’ perceptions about the introduction of performance-based financing in Benin: a case study in two health districts

“…Stakeholders perceive it as some additional programme, and the two cases we studied rather constitute hybrid approaches containing partial elements of PBF juxtaposing on old rules and institutions. A comparison between how the two PBF approaches under consideration in this paper are currently implemented and international best practices (4,5) points to some design flaws that prevent PBF to be fully operational. Especially, one can point the relatively low effective management freedom of health facilities (even those under treatment in the WB approach since they still rely on centralised resource allocation rules for most of their budget as well as for personnel management), the disconnection from other reform processes such as decentralisation, the duplication with usual activities (notably monitoring) and the relatively low budget of PBF (amounting to about 1 US dollar per capita per year in the BTC approach and 2.17 US dollars per capita per year in the WB approach, which is judged insufficient compared to the international standard of about 3 US dollars (4,5).…”

“…Indeed, as for any policy, there might be some gap between policy and practice. A first gap can be found between the PBF 'pure approaches' such as found in the literature (4,5) and the approaches developed in Benin. A second gap, which is more important from the perspective of sociology and grounded studies, relates to the divergences between what is supposed to be done according to the country frameworks, and what is observed on the field (which could be called 'temporary results').…”

“…Besides, the research intends to isolate, whenever possible, the influence of the various elements of the PBF 'package' . Practitioners have identified a number of best practices and criteria to establish how far a project is 'PBF' (4,5). As some of these were still not effective when we performed our study and/or were too difficult to grab through interviews with local stakeholders, we mostly turned our attention to the following elements: performance premiums, overall resource increase, using indicators to clarify priorities, strengthened 'vertical' control, strengthened community control, increased management freedom, and capacity building initiatives provided in the context of PBF.…”

“…However, differences are noted at the levels of the policy formulation and design; institutions in place; indicators; and costs at stakes (6). Following encouraging experiences in various countries, PBF in the health sector has now been adopted as pilots or national policy by many African countries and communities of practice have developed so as to share experiences and professionalise the business (4,5,(7)(8)(9). However, the jury is still out as for its impact (10)(11)(12), and numerous theoretical and empirical studies mention possible contradictory effects linked to the introduction of PBF in a complex system (13)(14)(15)(16).…”

Motivating health workers up to a limit: partial effects of performance-based financing on working environments in Nigeria

“…Many low-and middle-income countries (LMICs) have adopted performance-based financing (PBF) to improve health service delivery and outcomes (Fritsche et al 2014). PBF is a results-based financing (RBF) approach where financial incentives are directed to providers, on a fee-for-service basis, contingent on the quality of services provided (Musgrove 2011).…”