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The performance based financing is defined as financial incentives to motivate the production of more quantity of services and to comply or adhere to quality standards. There are different definitions per the problems to solve and the objectives to achieve. The names are many: PBF (Performance Based Financing), RBF (Results Based Financing), P4P (Pay for Performance), PBC (Performance Based Contracting), PIP (Practice Incentives Program), QOF (Quality and Outcomes Framework), etc. Why financing health service delivery per performance, results, outputs, and outcomes; whatever you call it? There are two main reasons: (i) the current financing system is inputs based. Inputs are equipment, drugs and consumables, salaries, etc.

In real situations, it is difficult to have all items together to expect results. You can have laboratory equipment and lack reagents or technicians. It’s why the investments done in health sector don’t produce expected results. It is “value of money issue”.

When you agree with the hospital or the clinic to achieve measurable results like number of antenatal care services or vaccinations, if there are results, you will pay; (ii) the other reason is because the health service delivery is done by a team of staff; unfortunately, the payment of the health personnel is individual based. Many organizations, especially the governments (main owners of health care facilities) have no customize remuneration systems for the health personnel. They use the traditional salary and benefits system.

For example,

to complete properly a surgery service, a surgeon and anesthetist can be motivated, but the technician for material sterilization or the assistant nurse not.

Meaning that to obtain the maximum of return in financing health service delivery, it requires you attach the financing to the expected result and give flexibility to the providers for having required inputs and put in places the best procedures. Financing health results requires an engine. The engine is somehow more complex as new performing engines. PBF is not a simple purchase of services, as it requires technical judgment of the products when buying. Usually the provider has or pretends to be the one who has the technical skills. It’s why qualified and independent evaluation is to be done to avoiding the conflict of interests of the both sides (purchaser and provider). What makes the PBF scheme much complex is the fact that it is mainly used by the public system, with many layers (ministry of finances, ministry of health, local government, project management unit, etc.). In summary, for ensuring the PBF scheme will work well, a well design system is key. This article summaries proposed key functions that can facilitate proper operating the performance based financing scheme.

The full article with the operational functions is at the "Medical Publication Marketplace"