Research for stronger health systems during and after crisis

Performance-based financing in three humanitarian settings - a new paper

Wednesday, 27 Jun 2018


Principles and pragmatism

A new paper by the ReBUILD Consortium has been published in Conflict & Health journal this week, looking at the issue of health system financing. ‘Performance-based financing in three humanitarian settings: principles and pragmatism’ considers performance-based financing (PBF) and examines why and how PBF has emerged and has been adapted to unsettled and dynamic contexts, what the opportunities and challenges have been, and what lessons can be drawn.

The team, led by Professor Sophie Witter of the Institute for Global Health and Development at Queen Margaret University, Edinburgh, conducted a comparative study based on data collected at national and subnational levels in northern Nigeria, Central African Republic and South Kivu in the Democratic Republic of Congo.

They found that the challenging environments required a high degree of PBF adaptation and innovation, leading the team to develop an analytical framework to highlight the key nodes where adaptations happen, the contextual drivers of adaptation, and the organisational elements that facilitate adaptation and may sustain PBF programmes.

The paper emphasises the importance of pragmatic adaptation in PBF design and implementation to reflect contextual specificities, and identifies elements that could facilitate adaptations and innovations. The findings and framework may spark reflection among PBF donors and implementers on the relevance of incorporating, reinforcing and building on those elements when designing and implementing programmes.


About performance-based financing

PBF schemes typically aim to improve health services by providing bonuses to service providers (usually facilities, but often with a portion paid to individual staff) based on the verified quantity of outputs produced. They have been expanding rapidly across low and middle-income countries in the past decade, particularly focused on maternal and child health services, with considerable external financing from multilateral, bilateral and global health initiatives. Many of the countries adopting PBF have been FCAS.

There’s more on the ReBUILD Consortium’s work into PBFs and other aspects of health financing in our resources section.


Access the paper

Bertone MP1, Jacobs E2, Toonen J2, Ngozi Akwataghibe2, Witter S1 (2018) Performance-based financing in three humanitarian settings: principles and pragmatism. Conflict and Health (2018) 12:28

1 ReBUILD & Institute for Global Health and Development, Queen Margaret University, Edinburgh (UK)
2 Royal Tropical Institute (KIT), Amsterdam (the Netherlands)