ReBUILD and performance-based financing – the story continues
18 March 2021
In 2016-18, ReBUILD undertook a series of ground-breaking studies on performance-based financing (PBF), focusing on experiences in fragile and conflict-affected settings (FCAS).
This work involved:
- Analysing why PBF has been so commonly adopted in FCAS countries, despite the constraints.
- Assessing how it has been adapted in humanitarian settings and how PBF integrates with wider health financing arrangements in these areas.
- Understanding the political economy drivers and impacts of PBF in Sierra Leone and also in Zimbabwe.
- Unpacking the impacts of PBF on strategic purchasing in fragile states, including in Zimbabwe and also in Uganda and DRC.
- Studying the role of PBF within the complex remuneration of health workers in Sierra Leone.
Findings were shared during active engagements with a wide variety of organisations that invest in PBF, including the World Bank, World Health Organization and bilateral funders such as the UK’s then Department for International Development, as well as a wider community of practice on PBF [opens an external webpage]. These findings are also summarised in a ReBUILD briefing paper.
Since the end of the first phase of ReBUILD, the team has continued to push forward this field. As well as further research, the team has continued to engage actively in policy and practice dialogues to support more effective and evidence-based health financing mechanisms which support progress towards universal health coverage and the broader set of health-related Sustainable Development Goal targets [opens an external webpage]. While the original work had a clear focus on PBF in fragile settings, some of the ongoing work is looking more broadly at the experiences and lessons from PBF approaches in wider low and middle-income settings. However, the specific learning from FCAS settings continues to be highly relevant in these broader policy discussions, as fragile states were early adopters of PBF and bring out strongly the need for context-adapted models.
- A team led by Sophie Witter at Queen Margaret University has updated the Cochrane review of PBF in low and middle-income states, providing the latest evidence synthesis in this rapidly growing field. Read that paper on the Cochrane website.
- Findings from the ReBUILD studies and the Cochrane review were shared as part of a series of World Bank global results-based financing (RBF) reflection workshops in February-March 2021.
- The team has also presented to the Health Financing Accelerator* and the Global Fund in March 2021 on the challenges and opportunities for international agencies investing in PBF and direct facility financing in FCAS and low-income settings. View that presentation here.
ReBUILD for Resilience will continue to engage in the research and policy issues around PBF and wider health financing in fragile and shock-prone settings (see this WHO report with contributions from ReBUILD members), especially given the new challenges thrown up by the COVID-19 pandemic (see this Health Systems Global paper Health Financing in Response to Covid-19: An Agenda For Research).
Further information on performance-based financing
Contact Professor Sophie Witter via the Queen Margaret University website.
All performance-based financing related ReBUILD resources can be found here.
*The Health Financing Accelerator [opens an external webpage] is one of a series of ‘accelerator’ initiatives, under the Global Action Plan for Healthy Lives and Well-being for All [opens an external webpage] where global health agencies are working together to assist countries in building their capacity to raise adequate and sustainable revenue through pro-poor and pro-health fiscal policies, give more priority to health and improve the efficiency and equity of health spending in support of health-related Sustainable Development Goals.