Results based financing

Results based financing (RBF), or performance-based financing (PBF), is a results-focused approach for incentivizing health service providers to focus on performance, quality, staff retention, health outputs and outcomes. It also serves as a foundation for improving public accountability for provider/facility performance and, increasingly a focus for broader health systems strengthening.

To support long-term sustainability, Health Partners International uses evidence on the costs and benefits of RBF to assist donors and governments in assessing how RBF processes can be adapted and successfully be implemented with both demand and supply side interventions. We provide technical assistance to government and private not-for-profit and faith-based service providers to strengthen their management capacity and effectively use limited resources.

HPI implements performance-based contracts and provides management capacity building services to improve quality, data use and community participation in health interventions.  We incentivise service providers by linking disbursements to performance, thus encouraging commitment, innovation and efficiency.

Read more about our experience of implementing a controlled trial in Northern Uganda (NU Health) designed to assess the costs and benefits of Results Based Financing versus conventional Input Based Financing.

NU Health generated rich, multi-dimensional data related to innovative practice in health systems development.  In particular, there were significant improvements in a range of key indicators in the Results Based Financing facilities relative to the Input Based Financing facilities. Overall, in RBF versus IBF, a child was:

  • Three times more likely to be treated correctly for malaria.
  • Over six times more likely to be treated correctly for pneumonia.
  • Over eight times more likely to be treated correctly for diarrhoea.

The main effect in terms of quality of care was differentiated by level of institution.  The strongest improvements were observed in lower level facilities.  Indicators related to both utilisation and supply of essential medicines similarly showed the most improvement in the lower level facilities in the RBF arm relative to the IBF arm.

With the introduction of more predictable health system support and the incentive-verification system provided by RBF, front-line staff were able to improve both the quality and quantity of health services in these lower level facilities.  The findings of this study support the assertion that by increasing access to and utilisation of better quality services, Results Based Financing can contribute to improving health system performance and achieving Universal Health Coverage.