Performance based financing : an international review of the literature
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Abstract:
Health research evidence from developing countries points to the challenges that are implicit in under resourced health sectors with associated lack of infrastructure, human resource capacity and supplies resulting in low productivity of service providers and poor healthcare utilization1. Efforts by international development assistance has focused on investing funds (input based) to invigorate poorly functioning public health systems in developing countries over the decades Public providers who are paid a low government salary have little incentive to provide more or better care. This has led to an enquiry by donors and implementing agencies on how to support public health systems through adoption of reward or incentive based approaches.
There are varied definitions used to describe the levels of incentives and performance rewards, whether organizational which includes: RBF; “results based performance”, P4P; (payment for performance) and PBF; performance based financing. For the purpose of this review, we will adopt “performance based financing” as the working terminology. Performance Based Financing (PBF) is predicated on the assumption that linking incentives to performance will contribute to improvement in access, quality and equity of service outputs. In some instances NGOs are fund holders, who in turn establish performance based contracts with district level administrations or with other non government entities. In other countries (Tanzania and Zambia for example) the fund holder is a government entity that channel the NGO money while Rwanda now has a government fund holder. The contracts in all cases employ a business plan whereby health worker incentives are tied to performance, based on an agreed set of indicators. PBF is currently viewed as a promising and innovative strategy to tackle issues related to improved access, utilization, and provider performance2.
In this literature review, we will explore incentive based approaches adopted in developing countries over the past decade, with a focus on the contribution of Performance Based Financing (PBF) to productivity, quality of health care and ultimately on the performance of health providers. Section One outlines the various definitions that are applicable to a wide range of performance based incentive schemes. Section Two reviews the institutional approaches that have been deployed by NGOs in collaboration with country level stakeholders, with a specific focus on the costs of introducing PBF using diverse operational approaches. Section Three explores the results that have been reported including both quantitative and qualitative effects on health service delivery and human resources. Section Four identifies the monitoring and evaluation tools that have been used to measure the results of PBF. Section Five offers a concluding summary with a proposed research agenda for future work.
Authors:
Canavan, A.
,
Toonen, J.
,
Elovainio, R.
Category:
Research
Keywords:
health services
,
human resource management
,
finance
,
evaluation
Language:
eng
Organization:
KIT - Royal Tropical Institute
PAGE:
ii, 24
Place:
Amsterdam
Publisher:
Royal Tropical Institute (KIT). Development Policy & Practice
Year:
2008
Right:
© 2008 Royal Tropical Institute
Subject:
Health and Nutrition
Title:
Performance based financing : an international review of the literature