Performance based financing of priority health services

Overview

Maternal mortality and child malnutrition rates in Burundi were among the highest in Africa in the mid-2000s, with limited use of maternal and child health services believed to be one of the main contributing factors. In response, the Government introduced a policy of free health care for children under five and for pregnant women, which successfully led to a dramatic increase in the use of services among these target groups. However, the increase put pressure on the already thinly stretched staff and resulted in frequent stock-outs of medicines, leading to a deterioration of performance. To meet the increased demand, a performance-based financing mechanism was introduced in 2010 after pilot testing in all contracted public and private (including faith-based) health facilities. The paper discusses how this new initiative that integrated provider payment reform with the free care policy and its impacts on quality and the productivity and use of maternal and child health services in Burundi.

Synthesis report

The Burundi case study is part of a synthesis report that applied a causal framework to synthesize lessons from ten case studies of various health system reforms which aimed to improve the efficiency in health systems.

Reforms for improving the efficiency of health systems: lessons from 10 country cases