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Can performance-based financing be used to reform health systems in developing countries?
Megan Ireland1, Elisabeth Paul, Bruno Dujardin
1School of Public Health, Université Libre de Bruxelles, Brussels, Belgium. megan.ireland@ulb.ac.be
Bulletin of the World Health Organization
|September 8, 2011
Summary
Performance-based financing (PBF) in developing countries, while aiming to improve health worker performance, may not sufficiently address patient and community needs. Evidence supporting PBF as a broad health sector reform tool is limited and context-dependent.
Area of Science:
- Health Policy and Systems Research
- Global Health
- Health Economics
Background:
- Performance-based financing (PBF) has expanded in developing nations, especially in Africa, over 15 years.
- National-scale PBF implementation in Burundi and Rwanda has led to its perception as a health sector reform strategy.
Purpose of the Study:
- To critically evaluate the notion of PBF as a comprehensive health sector reform tool.
- To highlight the limitations of results-based and economically driven interventions in addressing patient and community needs.
Main Methods:
- Critical analysis of existing literature and evidence on PBF implementation.
- Examination of the assumptions and claims surrounding PBF as a reform strategy.
Main Results:
- PBF, driven by economic incentives, may not adequately respond to patient and community health needs.
- The current debate on PBF is influenced by limited, unsubstantiated evidence lacking contextual understanding.
Conclusions:
- PBF should not be viewed solely as a strategic health sector reform tool.
- Health system reform must be fundamentally based on patient and community needs, not just economic incentives.
- Further research is needed to understand the nuanced impact of PBF, considering context and specific intervention components.
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