MSH Celebrates the World Bank’s Release of the Performance-Based Financing Toolkit

On February 26, the World Bank published the Performance-Based Financing (PBF) Toolkit. Management Sciences for Health’s (MSH) Cedric Ndizeye, Principal Technical Advisor for USAID’s Integrated Health Systems Strengthening Project (IHSSP), is a key contributor. 

PBF incentivizes strong performance by distributing financial payments, bonuses, and public recognition based on achievement of measurable performance targets and penalizes underperformance by withholding or reducing bonuses and payments. PBF has improved health service delivery in many countries by increasing the use and quality of health services, stabilizing or decreasing the costs of these services, supporting the effective use of limited resources, and improving staff motivation and retention.  

PBF approaches are expanding rapidly in lower-and middle income countries but a lack of knowledge among many health reformers on how to implement and scale up PBF pilot projects remains. To address this need, the PBF Toolkit contains documents and tools to guide program implementers including costing tools, sample PBF models, orientation and training presentations, service selection spreadsheets, and sample terms of reference, reports, and invoices. The toolkit also and includes experiences from those who have applied PBF techniques. 

  • Part one (chapters 1-8) provides an overview of facility-level design issues. 
  • Part two (chapters 9-16) discusses design structures and implementation issues. 
  • Part three (chapter 17) addresses the current evidence on PBF schemes and contrasts a variety of implementation approaches from lower- and middle- income countries.

Testimonials from PBF implementers and advocates attest to the effectiveness of this approach and support the value of the PBF Toolkit for expanding evidence-based implementation of PBF approaches: 

 “My delight is that the introduction of the performance-based financing program has brought a total change in Mayo-Ine Health Center with active community involvement, now providing the entire Minimum Package of Activities, bringing succor to the catchment area population with a significant improvement in the utilization of primary health care services.” 
—Aishatu Kadiri, community health officer at the Mayo-Ine Health Center in Adamawa State, Nigeria

 “Before PBF, we received every day dozens of complaints from clients and patients on poor quality of services and weak staff responsiveness because of chaos that hospital management could not address due to a lack of decision-making power. Thanks to PBF, we can plan and execute actions ourselves with our own resources. Complaints have been reduced a lot, conditions have been improving, and staff is more responsive to the needs of the patients.”
Dr. Mohammad Nadar, director of the provincial hospital in Tirin Kowt, Urozgan, Afghanistan  

 “Results-based financing is now an important part of the health system toolbox of most African countries. It proves to be a game changing instrument for better governance: getting money to the service delivery frontline including to the most remote areas, fostering autonomy, linking decentralization to performance, giving a new life to the information system, and transforming the wage and incentives environment towards better efficiency and equity of health services.”
Agnes Soucat, the African Development Bank’s Human Development Director 

Access the toolkit through the World Bank’s Open Knowledge Repository