Is Performance-Based Financing A Pathway to Strategic Purchasing in Sub-Saharan Africa? A Synthesis of the Evidence
ABSTRACTMany countries in sub-Saharan Africa have implemented performance-based financing (PBF) to improve health system performance. Much of the debate and analysis relating to PBF has focused on whether PBF “works”—that is, whether it leads to improvements in indicators tied to incentive-based pay...
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| Format: | Article |
| Language: | English |
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Taylor & Francis Group
2022-03-01
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| Series: | Health Systems & Reform |
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| Online Access: | https://www.tandfonline.com/doi/10.1080/23288604.2022.2068231 |
| _version_ | 1811173674403758080 |
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| author | Dennis Waithaka Cheryl Cashin Edwine Barasa |
| author_facet | Dennis Waithaka Cheryl Cashin Edwine Barasa |
| author_sort | Dennis Waithaka |
| collection | DOAJ |
| description | ABSTRACTMany countries in sub-Saharan Africa have implemented performance-based financing (PBF) to improve health system performance. Much of the debate and analysis relating to PBF has focused on whether PBF “works”—that is, whether it leads to improvements in indicators tied to incentive-based payments. Because PBF schemes embody key elements of strategic health purchasing, this study examines the question of whether and how PBF programs in sub-Saharan Africa influence strategic purchasing more broadly within country health financing arrangements. We searched PubMed, Scopus, EconLit, Cochrane Database of Systematic Reviews, Google Scholar, Google, and the World Health Organization and World Bank’s repositories for studies that focused on the implementation experience or effects of PBF in sub-Saharan African and published in English from 2000 to 2020. We identified 44 papers and used framework analysis to analyze the data and generate key findings. The evidence we reviewed shows that PBF has the potential to raise awareness about strategic purchasing, improve governance and institutional arrangements, and strengthen strategic purchasing functions. However, these effects are minimal in practice because PBF has been introduced as narrow, often pilot, projects that run parallel to and have little integration with the mainstream health financing system. We concluded that PBF has not systematically transformed health purchasing in countries in sub-Saharan Africa but that the experience with PBF can provide valuable lessons for how system-wide strategic purchasing can be implemented most effectively in that region—either in countries that currently have PBF schemes and aim to integrate them into broader purchasing systems, or in countries that are not currently implementing PBF. We also concluded that for countries to pursue more holistic approaches to strategic health purchasing and achieve better health outcomes, they need to implement health financing reforms within or aligned with existing financing systems. |
| first_indexed | 2024-04-10T17:50:59Z |
| format | Article |
| id | doaj.art-91271b85a97a4b92a5b5056f04375946 |
| institution | Directory Open Access Journal |
| issn | 2328-8604 2328-8620 |
| language | English |
| last_indexed | 2024-04-10T17:50:59Z |
| publishDate | 2022-03-01 |
| publisher | Taylor & Francis Group |
| record_format | Article |
| series | Health Systems & Reform |
| spelling | doaj.art-91271b85a97a4b92a5b5056f043759462023-02-02T21:30:22ZengTaylor & Francis GroupHealth Systems & Reform2328-86042328-86202022-03-018210.1080/23288604.2022.2068231Is Performance-Based Financing A Pathway to Strategic Purchasing in Sub-Saharan Africa? A Synthesis of the EvidenceDennis Waithaka0Cheryl Cashin1Edwine Barasa2Health Economics Research Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, KenyaResults for Development Institute, Washington, D.C, USAHealth Economics Research Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, KenyaABSTRACTMany countries in sub-Saharan Africa have implemented performance-based financing (PBF) to improve health system performance. Much of the debate and analysis relating to PBF has focused on whether PBF “works”—that is, whether it leads to improvements in indicators tied to incentive-based payments. Because PBF schemes embody key elements of strategic health purchasing, this study examines the question of whether and how PBF programs in sub-Saharan Africa influence strategic purchasing more broadly within country health financing arrangements. We searched PubMed, Scopus, EconLit, Cochrane Database of Systematic Reviews, Google Scholar, Google, and the World Health Organization and World Bank’s repositories for studies that focused on the implementation experience or effects of PBF in sub-Saharan African and published in English from 2000 to 2020. We identified 44 papers and used framework analysis to analyze the data and generate key findings. The evidence we reviewed shows that PBF has the potential to raise awareness about strategic purchasing, improve governance and institutional arrangements, and strengthen strategic purchasing functions. However, these effects are minimal in practice because PBF has been introduced as narrow, often pilot, projects that run parallel to and have little integration with the mainstream health financing system. We concluded that PBF has not systematically transformed health purchasing in countries in sub-Saharan Africa but that the experience with PBF can provide valuable lessons for how system-wide strategic purchasing can be implemented most effectively in that region—either in countries that currently have PBF schemes and aim to integrate them into broader purchasing systems, or in countries that are not currently implementing PBF. We also concluded that for countries to pursue more holistic approaches to strategic health purchasing and achieve better health outcomes, they need to implement health financing reforms within or aligned with existing financing systems.https://www.tandfonline.com/doi/10.1080/23288604.2022.2068231Performance-based financingresults-based financingreviewstrategic purchasingSub-Saharan Africa |
| spellingShingle | Dennis Waithaka Cheryl Cashin Edwine Barasa Is Performance-Based Financing A Pathway to Strategic Purchasing in Sub-Saharan Africa? A Synthesis of the Evidence Health Systems & Reform Performance-based financing results-based financing review strategic purchasing Sub-Saharan Africa |
| title | Is Performance-Based Financing A Pathway to Strategic Purchasing in Sub-Saharan Africa? A Synthesis of the Evidence |
| title_full | Is Performance-Based Financing A Pathway to Strategic Purchasing in Sub-Saharan Africa? A Synthesis of the Evidence |
| title_fullStr | Is Performance-Based Financing A Pathway to Strategic Purchasing in Sub-Saharan Africa? A Synthesis of the Evidence |
| title_full_unstemmed | Is Performance-Based Financing A Pathway to Strategic Purchasing in Sub-Saharan Africa? A Synthesis of the Evidence |
| title_short | Is Performance-Based Financing A Pathway to Strategic Purchasing in Sub-Saharan Africa? A Synthesis of the Evidence |
| title_sort | is performance based financing a pathway to strategic purchasing in sub saharan africa a synthesis of the evidence |
| topic | Performance-based financing results-based financing review strategic purchasing Sub-Saharan Africa |
| url | https://www.tandfonline.com/doi/10.1080/23288604.2022.2068231 |
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