In this study, the authors examine the question of whether and how PBF programs in sub-Saharan Africa influence strategic purchasing more broadly within the country’s health financing arrangements. Many countries in sub-Saharan Africa have implemented performance-based financing (PBF) to improve health system performance. The World Health Organization (WHO) defines PBF as
a form of service provider payment where financial incentives are directed only to healthcare providers (not beneficiaries) when they achieve pre-determined verified performance targets, often defined in terms of process or output indicators, adjusted by some measure of quality.
If done effectively, PBF can be a tool which can improve strategic purchasing and help improve access to quality health care especially among the vulnerable. Nevertheless, PBF has been one of the most studied and debated health financing approaches over the past decade. Much of the debate and analysis relating to PBF has focused on whether PBF “works”—that is, whether it leads to improvements in indicators tied to incentive-based payments.
The findings of this study show that indeed PBF has the potential to raise awareness about strategic purchasing, improve governance and institutional arrangements, and strengthen strategic purchasing functions. However, these effects are minimal in practice because PBF has been introduced as narrow, often pilot, projects that run parallel to and have little integration with the mainstream health financing system.
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