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Performance-based financing in three humanitarian settings: principles and pragmatism.

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Performance Based Financing (PBF) requires adaptation in humanitarian settings. Pragmatic adjustments, organizational flexibility, and local partnerships are key to successful health financing in fragile contexts.

Keywords:
Central African RepublicDR CongoFragile and conflict-affected settingsImplementation processNigeriaPerformance based financing

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Area of Science:

  • Global Health
  • Health Systems Strengthening
  • Development Economics

Background:

  • Performance-Based Financing (PBF) is increasingly used in low- and middle-income countries, including fragile and humanitarian settings.
  • Limited literature exists on PBF adaptation to diverse contexts and the influence of these contexts on PBF implementation.
  • This study investigates PBF adaptation in three humanitarian settings: northern Nigeria, Central African Republic, and South Kivu (DRC).

Purpose of the Study:

  • To examine the reasons and methods behind PBF adaptation in unsettled and dynamic humanitarian contexts.
  • To identify the opportunities and challenges associated with PBF implementation in these settings.
  • To draw lessons for future PBF programming in fragile environments.

Main Methods:

  • A comparative case study approach was employed.
  • Data collection included document review, 35 key informant interviews, and 16 focus group discussions.
  • Analysis focused on describing contextual fragility, health system implications, and PBF adoption, implementation, and adaptation processes.

Main Results:

  • Challenging humanitarian environments necessitated significant PBF adaptation and innovation, sometimes deviating from established principles.
  • An analytical framework was developed to identify adaptation nodes, contextual drivers, and facilitating organizational elements.
  • Key adaptations were observed in response to acute crises, coordination with humanitarian actors, and community engagement.

Conclusions:

  • Pragmatic adaptation of PBF is crucial to align with specific contextual needs in fragile settings.
  • Organizational flexibility, local expertise, and sustained partnerships are vital for successful PBF adaptation and innovation.
  • Findings offer insights for PBF donors and implementers to enhance program design and sustainability.