Counter-verification in performance-based financing: key insights from the Côte d'Ivoire experience

Area of Science:

• Health financing
• Public health policy
• Program evaluation

Background:

• Performance-based financing (PBF) is a significant health reform in sub-Saharan Africa.
• Verification is crucial in PBF, but counter-verification remains under-researched.
• This study investigates counter-verification within Côte d'Ivoire's PBF program.

Purpose of the Study:

• To examine counter-verification activities in Côte d'Ivoire's PBF program.
• To identify implementation challenges and insights.
• To analyze discrepancies between verified and counter-verified data.

Main Methods:

• Content analysis of 14 quarterly counter-verification reports (Q4 2016-Q3 2023).
• Supplemented by informal discussions.
• Utilized the READ approach for systematic data extraction and analysis, focusing on discrepancies and their causes.

Main Results:

• Mixed results in comparing verified and counter-verified data; discrepancies decreased for some activities but persisted or worsened for others.
• Primary causes of discrepancies: inadequate record-keeping and failure to meet indicator validation criteria.
• Challenges included poor physical/electronic archiving and insufficient qualified personnel; audits revealed shortcomings in administrative/financial procedures.

Conclusions:

• Counter-verification is vital for PBF to enhance credibility, correct errors, and prevent misconduct.
• Systematic integration of counter-verification into PBF program design is essential for optimizing its impact.