Health financing for universal coverage

Learning lessons on implementing performance-based financing, from a multi-country evaluation

Synthesis report, 2009

Royal Tropical Institute/Cortaid/World Health Organization

Publication details

Number of pages: 57
Publication date: 2009
Languages: English



In recent years the ‘Performance Based Financing’ (PBF) approach has received increasing attention. Evidence to date has largely demonstrated that the actual ‘modality input planning’ does not incite health providers to perform better, because money flows are not linked to results. The professionals and constituencies that are in favour of PBF support the hypothesis that enhanced productivity and quality of care are contingent on linking outputs to financial incentives.

However, benefits of performance based financing are still inconclusive with suggestions that it is not sustainable, it will not have a proper effect, or it may create perverse incentives. The evidence up to now cannot fully substantiate either debate sufficiently in the absence of more extensive operational research and formative evaluations.

This synthesis report thereby explores the lessons learned on design, implementation and effects of financial incentives in the form of performance based financing in the health sector, as supported in Sub–Saharan Africa by the two Dutch NGO’s Cordaid and HealthNet TPO. Towards this aim a multi-country study was undertaken led by the Royal Tropical Institute of the Netherlands (KIT) in collaboration with World Health Organization (WHO) Geneva and the implementing agencies in DRC, Burundi, United Republic of Tanzania and Zambia. Rwanda was also visited to study scaling-up from pilot projects to a national program.