What is performance- based financing (PBF)? Why is this used to finance health services in lower- and lower- middle- income countries? If practitioners want to introduce PBF in their country, how shall they do it?
This toolkit addresses the questions what and why, while focusing on the answer to how it can be done. The toolkit is pervaded by answers to the first question, while explaining the “how to”: the process, the planning, the design, and the implementation of PBF schemes. It is written and reviewed by practitioners who have experimented with various methods and who have designed, implemented, witnessed, and evaluated its effects. Methods and approaches in PBF evolve continuously. Even though the toolkit provides guidance based on experience, the experience itself is based on trial and error and constant testing, assessing, and reassessing. And this approach is why the toolkit is not meant as a final product. It attempts to capture the current state of affairs and best practices, while attempting to stay abreast by updating the methods, experiences, and tools used.
Performance-based financing (PBF) approaches have expanded rapidly in lower-and middle income countries, and especially in Africa. The number of countries has grown from three in 2006 to 32 in 2013. PBF schemes are flourishing and cause considerable demand for technical assistance in executing these health reforms in a rational and accountable manner. Currently there is a lack of knowledge among many health reformers of how to implement performance-based financing pilot projects, and scale them up intelligently.
In a context of tremendous demand for solid design and implementation experience and given the rapid expansion of results-based financing (RBF) programs, there is an urgent need to build capacity in designing and implementing PBF programs. As yet there has been little attempt to gather the learning from these experiences together in one volume and, moreover, in a form that serves as a guide to implementers.
As this toolkit demonstrates, performance-based strategies have evolved a great deal through testing and modifi cation. There is a huge wave of improvement starting to break across Africa, Asia, and Latin America, enabling poor people to access quality health services and health facilities to motivate their staff and rebuild their dilapidated health infrastructure.