Results-Based Financing Research

In spite of billions of dollars of investment spent to improve the performance of health systems in low-and-middle income countries (LMICs), approximately 400 million people still lack access to adequate healthcare, and health outcomes have often not improved as expected according to a WHO and World Bank Report titled:
Tracking universal health coverage: First Global Monitoring Report.

One of the mechanisms that aims to improve the efficiency of the health system is Results-Based Financing (RBF). This is a method where a cash payment or non-monetary transfer is made to a health provider as an incentive to improve the quality and availability of a health service, or for a patient to use this service. Payment is made based on whether the service was delivered and used according to prearranged criteria. More than 30 LMICs, particularly in sub-Saharan Africa have implemented RBF pilot projects and some of these are moving towards scale-up.
However, RBF programmes in LMICs have largely been implemented and studied as stand alone programmes. Research conducted on RBF has largely focused on impact evaluation, which does not inform what makes some RBF programmes succeed and others fail.

Alliance approach

To address this knowledge gap, the Alliance and partners conducted research to understand what enables or hinders the transition of RBF initiatives from pilot projects to being fully integrated into national health systems.

Linking payment to performance can help to improve how the rest of the health system functions. For example, health services may need to be reorganized and health information systems may need to be adapted. Consequently, RBF programmes can serve as an entry point for improving health systems more broadly. Understanding this is important for funders and decision-makers as it enables them to learn from experiences of other countries, and avoid potential pitfalls in the design, adoption and implementation of RBF programmes at the national level.

Research updates

The Alliance is pleased to announce the publication of a Special Issue:"Taking Results-Based Financing from Scheme to System" in the Journal Health Systems and Reform. The issue consists of eight journal articles, including four country case studies, two cross-country analyses and two commentaries is largely based on this research programme that sought to examine how RBF pilot have been integrated into national health systems in 11 countries.
The research findings presented in this issue serve to reinforce the need for RBF schemes that consider the broader health system and that is aligned with the main goal of universal health coverage.