Performance-based financing in low-income and middle-income countries: isn’t it time for a rethink?

by Elisabeth Paul, Lucien Albert, Badibanga N’Sambuka Bisala et al.
BMJ Glob Health 2018 – Published 13 January 2018

8 pp. 354 kB
http://gh.bmj.com/content/bmjgh/3/1/e000664.full.pdf

This paper questions the view that performance-based financing (PBF) in the health sector is an effective, efficient and equitable approach to improving the performance of health systems in low-income and middle-income countries (LMICs). PBF was conceived as an open approach adapted to specific country needs, having the potential to foster system-wide reforms. However, as with many strategies and tools, there is a gap between what was planned and what is actually implemented. This paper argues that PBF as it is currently implemented in many contexts does not satisfy the promises. Too little care is given to system-wide and long-term effects, so that PBF can actually damage health services and systems. The paper ends by proposing entry points for alternative approaches.

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