Cordaid and Performance Based Financing
Performance Based Financing (PBF, or results-based funding), contributes to Cordaid’s aim of improving the access to quality health care. This is a summary of Cordaid’s position regarding the concept and the situations where it applies PBF within the area of health care provision. PBF directly links the amount of financing with measurable results. The financed organisation has to work oriented to results when deciding policies and using means, while enjoying ample freedom of choice. Indicators are defined to measure results. A contract outlines the relationship between indicator-based scores and the amount of financial support, and names minimum criteria for quality, accountability and good governance.
Modalities
PBF programmes in Rwanda, Burundi and DR Congo follow the systemic approach, in which entire health systems are reviewed. Health care systems here have limited government regulation and commitment, and paying patients cover much of the budget. Separate offices have been created to hire health care services. On the other hand, in Tanzania and Zambia institutions that hire health care already exist; therefore, priority is given to cooperation with decentralised governments and financing and planning mechanisms.
Successes, points of attention and preconditions
Rwanda’s PBF programme clearly enjoys positive results, such as more efficient health care institutions. In Tanzania, it seems that costs have decreased and access to health care has increased. Literature also points out the programmes’ efficiency and effectiveness.
However, when implementing PBF one must take care that it fits in with existing systems. Implementation should ensure the development of capacity and must be laid down in contract. Long-term incentives and an exit strategy should ensure sustainability. If health care systems exist and the government is involved, Cordaid’s contribution is smaller and might limit itself to output oriented work with existing partners. If social and institutional structures fail, a systemic approach to PBF is strongly applicable.
Cordaid should finance PBF programmes only at the onset, although it can play important roles in its implementation and organisational strengthening.
Indicators concerning quantity and quality should be carefully chosen and be geared to national priorities, while care should be taken to prevent their selectivity, guarantee accountability and involve the community or external consultants in monitoring. The management of health care institutions must be strong enough to anticipate the entrepreneurship of health providers. An equity fund must also exist for the poorest of the poor. Finally, insurers and community health funds can easily fit into a performance based system."
(Source: cordaidpartners.com, 2008)
