TY - JOUR T1 - Evaluating performance-based financing in low-income and middle-income countries: the need to look beyond average effect JF - BMJ Global Health JO - BMJ Global Health DO - 10.1136/bmjgh-2020-003136 VL - 5 IS - 8 SP - e003136 AU - Peter Binyaruka AU - Julia Lohmann AU - Manuela De Allegri Y1 - 2020/08/01 UR - http://gh.bmj.com/content/5/8/e003136.abstract N2 - Summary boxPerformance-based financing (PBF) is widely implemented despite limited available evidence on its effectiveness.There is a need to assess how PBF works in different contexts within and across settings in order to inform country-level decisions as to whether PBF may be a suitable health financing option and how it should be shaped to suit different contexts within a country.This commentary intends to inspire research looking beyond average programme effects into understanding heterogeneity in PBF programmes and their effects.As a starting point, we propose to document and analyse all potential sources of heterogeneity in PBF.We further provide initial guidance to conduct systematic analyses of heterogeneity of PBF by measuring and understanding differential effects and what drives or explains them.Over the last decade, performance-based financing (PBF) has gained momentum as a health financing innovation, which combines linking healthcare payments to performance with increased provider autonomy and supervision.1 2 The combination of these elements is expected to boost supply-side efforts towards increasing quantity and quality of service provision, triggering a demand-side response towards improved service utilisation.1 3 4A recent paper by Paul et al has critically questioned the widespread introduction of PBF in light of the limited available evidence on its effectiveness.5 The response to this paper has been varied, with authors advancing arguments for and against PBF. Some African PBF implementers have claimed that PBF is an evolving strategy with potential benefits on health systems despite its existing challenges.6 Others have drawn attention to the unintended consequences of PBF7 or to the need to assess the economic value of such an approach.8 Beyond their diverse arguments, however, most authors have concurred with Paul et al5 on the limited scope of currently available evidence and have postulated the need to better … ER -