RT Journal Article
SR Electronic
T1 Performance-based financing in low-income and middle-income countries: isn’t it time for a rethink?
JF BMJ Global Health
FD BMJ Publishing Group Ltd
SP e000664
DO 10.1136/bmjgh-2017-000664
VO 3
IS 1
A1 Paul, Elisabeth
A1 Albert, Lucien
A1 Bisala, Badibanga N’Sambuka
A1 Bodson, Oriane
A1 Bonnet, Emmanuel
A1 Bossyns, Paul
A1 Colombo, Sandro
A1 De Brouwere, Vincent
A1 Dumont, Alexandre
A1 Eclou, Dieudonné Sèdjro
A1 Gyselinck, Karel
A1 Hane, Fatoumata
A1 Marchal, Bruno
A1 Meloni, Remo
A1 Noirhomme, Mathieu
A1 Noterman, Jean-Pierre
A1 Ooms, Gorik
A1 Samb, Oumar Mallé
A1 Ssengooba, Freddie
A1 Touré, Laurence
A1 Turcotte-Tremblay, Anne-Marie
A1 Van Belle, Sara
A1 Vinard, Philippe
A1 Ridde, Valéry
YR 2018
UL http://gh.bmj.com/content/3/1/e000664.abstract
AB 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. First, since the start of PBF implementation in LMICs, concerns have been raised on the basis of empirical evidence from different settings and disciplines that indicated the risks, cost and perverse effects. However, PBF implementation was rushed despite insufficient evidence of its effectiveness. Second, there is a lack of domestic ownership of PBF. Considering the amounts of time and money it now absorbs, and the lack of evidence of effectiveness and efficiency, PBF can be characterised as a donor fad. Third, by presenting itself as a comprehensive approach that makes it possible to address all aspects of the health system in any context, PBF monopolises attention and focuses policy dialogue on the short-term results of PBF programmes while diverting attention and resources from broader processes of change and necessary reforms. Too little care is given to system-wide and long-term effects, so that PBF can actually damage health services and systems. This paper ends by proposing entry points for alternative approaches.