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Debate on Performance Based Financing: we welcome your contributions !

1/15/2018

40 Commentaires

 
Bruno Meessen


This weekend, a rather critical article about PBF in Low-and Middle-Income countries was published in the BMJ Global Health. In this blogpost, we present you how the blog Health Financing in Africa intends to enhance the forthcoming debate.


The article signed by Elisabeth Paul and twenty three experts is accessible here. It deserves to be read. Everyone must certainly make up his/her own mind. In a way, the article relaunches a controversy that took place in the WHO Bulletin seven years ago, following an article I wrote with Agnès Soucat and Claude Sekabagara (both at the World Bank at that time). The purpose of our paper was to ensure that the PBF experiences which were starting in many countries at the time were integrated in a systemic vision, focused on the strengthening but also transformation of health systems. Our article of 2011 was addressed to all.

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We first wanted to set the boundaries for the collective work in progress, as the PBF movement already involved many national decision-makers, experts, technical assistants, researchers and donors. We notably wanted to avoid a distortion of PBF (for example as a strategy “captured” by a global or national actor concentrating on a single disease).  We also aimed to help the actors not directly involved in  PBF to understand better what could be built together and how PBF could help, in the mid- and long term, the other interventions that make up the richness of a health system and the action of external partners in the poorest countries.

The debate has been relatively limited since then, as many actors were focused on the implementation of PBF pilot projects or, for those involving researchers, on sometimes sophisticated evaluation and research protocols. I also had the impression that many of the observers or experts involved in PBF voluntarily subscribed to a systemic view of PBF, at least as a working hypothesis.

In another contribution, I will explain what I have spent part of my own energy on for the past seven years. Let's say, in a nutshell, that I embarked, on top of my scientific work, with limited resources and a bit of a ‘can do’ spirit, on a collective adventure to rebuild knowledge management for health systems in the LMICs, together with many colleagues and friends. This commitment among others materialized in the co-facilitation of three communities of practice. The Health Financing in Africa Blog has been an important part of this adventure, since I served as its main editor, and have also been a regular contributor.

The article by Paul and al clearly aims to make waves, to provoke a reaction. The HFA blog, which covers health financing in Africa, broadly defined, has published many contributions on PBF in recent years. Along the same lines, we therefore welcome reactions on the text of Paul et al. The editorial line of HFA is clear: we welcome the contributions of all kinds of experts (policy makers, practitioners, researchers, technical assistants...). For this series, contributions about  implementation will be particularly valuable, since according to Paul et al, this implementation is very problematic. We will publish both contributions supporting the line developed by Paul et al and contributions challenging the viewpoint. We invite the speakers to argue their point of view well.

In their article, Paul and al express many criticisms against PBF, but also against some actors. The article claims among others that the PBF CoP is not open to controversy. As the main facilitator of the PBF CoP, I naturally take this claim personally. In another article, I will elaborate on why I disagree with this statement. But to avoid from now on any possible ‘conflict of interest’, I informed Isidore Sieleunou, the lead facilitator of the CoP Financial Access to Health Services, with which the PBF CoP shares the blog HFA, that I do not want to be editor for these future blogs on PBF. Instead, Isidore will oversee the process and will be assisted by other CoP experts currently being identified. So if you want to make a contribution, we ask you to contact Isidore through email.


40 Commentaires
Gyuri Fritsche
1/19/2018 07:43:51 am

Paul et all’s critique is welcome and the authors may have hit the nail on the head regarding a few issues that plague Performance-Based Financing (PBF) based health reforms (http://gh.bmj.com/content/3/1/e000664). The lack of domestic ownership as manifest in the absence of Government funding in some places, or troubles with design and implementation of PBF approaches are real indeed and can be the main reasons for why some PBF programs in Low, -and Middle Income Countries (LMIC) may fail. However, in their attempt to take on PBF exclusively, the authors overlook several important factors:

Firstly, they ignore the fundamental problems plaguing LMIC health sectors in general: remnants of dysfunctional and underfunded colonial centrally managed health systems, which are the root cause of unnecessary, high maternal and child mortality. The authors’ claims are based on a rather small set of contexts, of which one (Burkina Faso) is showing good results (Steenland, M., et al. (2017). "Performance-based financing to increase utilization of maternal health services: Evidence from Burkina Faso." Soc Sci Med(3): 179-184.) and an enhanced and expanded version of the Burkina Faso PBF approach awaiting the results of an impact evaluation. Their second case, that of Benin, involves a PBF program which was rather successful at the outset but suffering from a general lack of autonomy in the health system for providers leading to lesser results and being confronted with a new president changing the direction of these reforms. In addition, the case of Benin also suffered the consequences from an unsuccessful process to improve the design, to enhance Ministry of Health ownership and to harmonize different PBF approaches. Their third example, Tanzania, was a rather small Pay-for-Performance pilot, which had multiple design faults.

The authors do acknowledge, though, that where government ownership of PBF was present (as e.g. expressed in domestic funding) such as in Rwanda and Burundi, this contributed substantially to the documented success of PBF approaches in those countries.

Secondly, they claim that PBF approaches are not efficient. This is untrue. In their assessment of whether ‘things work’, the authors bypass one crucial effect of PBF approaches: The efficiency of PBF programs or cost-effectiveness of PBF approaches is essentially through the impact on the quality of health services, for instance for women and children benefiting from such PBF programs. This increase, notably in settings coming from very low baselines, is so strong that even a moderately successful PBF approach in Zambia was shown to have been a very cost-effective intervention. Other examples: the Cameroon PBF program had strong impact on quality of care too. A chief driver of success in the Nigerian PBF approach, one of the two largest in the world, covering three states, is an impressive double difference of 49-percentage point increase in a composite measure of structural and process measures of quality of health services as compared to control districts (results pending). Sure, a country the size of Nigeria faces many challenges, but In Nigeria, not just structural quality improved significantly, but also content of care measures such as clinical quality for children visiting outpatient clinics and pregnant mothers visiting antenatal care clinics.

So, what to conclude from the authors’ analysis?

There is nothing wrong in looking critically at things. But should we abandon PBF? The authors argue PBF approaches in LMIC should be abandoned because of the presumed mixed results in three examples. Certainly. programs with no or detrimental effects on quality care should be abandoned. Such as is the case in many free health care policies in which no attention is given to compensating providers for their lost income. But well designed, implemented and locally owned PBF programs have shown substantial improvements, and can lead to real results in difficult circumstances.

György Fritsche




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MARTINS
1/7/2025 11:40:38 pm

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3/3/2025 01:29:08 am

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6/20/2025 01:22:30 am

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ARSEN
7/8/2025 12:01:18 am

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HENRY MIKIEL
7/11/2025 07:37:24 pm

hello everyone i am Henry Mikiel from Florida a medical doctor i never believed herbal products could solve what my science technology could not solve ,i have been having little penis size since childhood and that really Embarass me alot and up till now that i am 37 years old i still find it difficult to find a permanent solution until my friend from Africa at work place introduce his uncle to me Dr Harry .he told me about his wonderful works and decided to contact him through his email he gave me [email protected] and he replied me and we discussed my situation and told me what i need to do ,i did it and received his herbal medicine through UPS and i got it within 3/5 days and used his miraculous herbal mixture cream just as he told me ,its just 4 days i started measuring and got 4 inches already and after two weeks i got 11 inches size and 8.0 girth size .i was so happy because no woman will dare reject me now with my big Cock .life is really full of surprises me that was having 2 inches before now having 11 inches big cock size .so if you need any help or cure to any sickness or disease like small penis,low sperm count,premature ejaculation,HIV/AIDS ,herpes ,spells of all kinds etc you can quickly visit his website link https://drharrysolutionhea.wixsite.com/healinghome
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12/28/2022 12:00:23 pm

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11/12/2024 10:37:00 pm

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12/8/2023 04:01:46 pm

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Naomi
9/20/2024 05:19:58 pm

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Randy link
9/24/2024 05:04:20 am

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Dr. Ayo Christopher
10/16/2024 10:18:10 pm


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glady
10/29/2024 09:12:47 pm

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11/27/2024 02:42:51 pm

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Lisa oney
11/30/2024 01:25:09 am

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melanin goins
12/2/2024 02:44:46 pm

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Wendy Joel
12/6/2024 06:53:48 am


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12/9/2024 12:56:34 am

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12/10/2024 11:06:46 am

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Jacqueline
12/12/2024 03:21:53 pm

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sonshine jojo
1/8/2025 07:44:27 am

I am so happy to testify of the good work of Dr. Payo, I have suffered from Herpes virus since 2020 and I had frequent symptoms in my private area. After some time it will go away after using acyclovir drugs, then come back after some months. It was disheartening since i have been diagnosed, but after finding Dr. Payo and his reviews i was convinced that he will definitely cure me and so i contacted him and he told me how to get his herbal medicine and using it for just two weeks and i will go for check up and first i said how can that be possible but i used his herbal medicine after making purchase and truly i used it and went for the test again, and my result came back negative. So I made it a task to share this good testimony on the internet so that those sick can benefit and get cured. you can contact him on WhatsApp or call: +2348110096692 or email: [email protected]

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Lisa Nayna Tumelo
1/12/2025 09:33:08 pm

The Great Dr.OLIHA Herbal medicine is a good or perfect cure remedy for HIV Virus, I was diagnosed of HIV for almost 5 years, everyday i am always on research looking for a perfect way to get rid of this terrible disease as i always knew that what we need for our health is right here on earth though the scientist say there is know cure for this disease,on my search I saw some different testimony on how Dr. OLIHA has been able to cure HIV with is herbal medicine. I decided to contact this man, I contacted him and he guided me on how to purchase the medicine. I asked him for solutions and he started the remedies for my health. Thank God, now everything is fine, I’m cured by Dr. OLIHA herbal medicine, I’m very grateful to Dr. OLIHA, reach him now on ([email protected] ) or you can also call him on +2349038382931.visit him website https://olihamiraclemedici.wixsite.com/drolihamiraclemedici

Dr. OLIHA Also Cures:
1. HIV/AIDS
2. HERPES 1/2
3. CANCER
4. ALS (Lou Gehrig’s disease)
5. Hepatitis B
6. chronic pancreatic
7. Emphysema
8. COPD (Chronic Obstructive Pulmonary Disease)
9. Asthma
10.Acute angle-closure Glaucoma
11. Diabetes
12.CHRONIC PANCREATIC
13.CHLAMYDIA
14.ZIKA VIRUS

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Jason Cooper
1/16/2025 09:23:05 am

God bless Dr Ughulu for his marvelous work in my life, I was diagnosed of Herpes simplex virus (HSV) since 2014 and I was taking my medications, I wasn't satisfied I needed to get the Herpes simplex virus (HSV) out of my system, I did a researched about some possible cure for Herpes simplex virus (HSV) I saw a comment about Dr Ughulu, how he cured Herpes simplex virus (HSV) with his herbal medicine, I contacted him and he guided me. I asked for solutions, he started the remedy for my health, he sent me the medicine through UPS SPEED POST. I took the medicine as prescribed by Dr Ughulu and 7 days later I was totally cured from Herpes simplex virus (HSV) . Thank you Dr Ughulu, get in touch with him too. WhatsApp: +1(720) 794-2516 Call Text Number: +1(252) 409-1841 Via: [email protected] Or website: https://drughulupowerfulsp.wixsite.com/my-site-ughulu

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oliver james
2/8/2025 10:31:11 pm

I got cured miraculously from HPV Virus using herbs by Dr. Guba who sent me some herbal medicines and I used them as instructed within two weeks. Before I knew I was totally healed, I visited my doctor for a medical examination. Behold, I am negative. I introduced this great doctor to a couple of infected friends who also tried the medication and they were cured as well . Please if you have this virus and you have tried so many things or have been deceived severally, here is your final solution for you send him an email via: [email protected] or WhatsApp: + 234 816 238 8034 or website: https://drgubahealingherbs.wixsite.com/guba-healing-herbs

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Grace
2/25/2025 04:10:00 pm

I have been suffering from Human papillomavirus (HPV) for the past 3 years and 8 months, and ever since then i have been taking series of treatment but there was no improvement until i came across testimonies of Dr Ogudugu on how he has been curing different people from different diseases all over the world, then i contacted him as well. After our conversation he sent me the medicine which i took according to his instructions. When i was done taking the herbal medicine i went for a medical checkup and to my greatest surprise i was cured from Human papillomavirus (HPV) My heart is so filled with joy. If you are suffering from (HPV) or any other disease you can contact Dr Ogudugu. EMAIL: [email protected] TEXT OR CALL: +2348163026536

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Success
3/3/2025 05:43:24 pm

Hello! I'm very excited to inform everyone that I'm completely cured from my HSV 1&2 recently. I have used Oregano oil, Coconut oil, Acyclovir, Valacyclovir, Famciclovir, and some other products and it's really help during my outbreaks but I totally got cured! from my HSV with a strong and active herbal medicine ordered from a powerful Traditional Healer and it completely fought the virus from my nervous system and I was tested negative after fews weeks of using the herbal medicine. I'm here to let you all know that herpes virus has a complete cure, I got rid of mine with the help of DR OGUDUGU a traditional Healer from west African and his herbal exploit. Contact him via mail: [email protected] /WhatsApp +2348163026536

Répondre
Esther
3/4/2025 02:46:38 pm

It's obvious some people with Herpes Virus are being prescribed antiviral and other supplementary Orthodox medicine just to suppress the virus and not a cure. I have had the virus since 2020 until I was introduced by a blogger who narrated her story online how she was cured of herpes after drinking herbal medicine. I quickly contacted him and requested the herbal medicine to cure myself and he asked for my address and he sent it to me directly, which I drank. All thanks to the creator for using this great herbalist to cure me from the virus so I have promised to keep telling good things about him, feel free to share with him if you got herpes on his Email: [email protected] WHATSAPP: +2348163026536 don’t forget to tell him I did refer you to him.

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LISA
3/9/2025 09:26:08 pm

I have been suffering from Herpes for the past 18 months, and ever since then i have been taking series of treatment but there was no improvement until i came across testimonies of Dr. ONOBUN on how he has been curing different people from different diseases all over the world, then i contacted him as well. After our conversation he sent me the medicine which i took according .to his instructions. When i was done taking the herbal medicine i went for a medical checkup and to my greatest surprise i was cured from Herpes. My heart is so filled with joy. If you are suffering from Herpes or any other disease you can contact Dr. ONOBUN today on this Email address: [email protected] or call / WhatsApp +2348051300199

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Anna joe
3/24/2025 02:25:54 am

i want to share to the whole world how Dr masako the Great of all the Spell Caster, that helped me reunite my marriage back, my Ex Husband broke up with me 3months ago, I have been trying to get him back ever since then, i was worried and so confused because i love him so much. I was really going too depressed, he left me with my kids and just ignored me constantly. I have begged him for forgiveness through text messages for him to come back home and the kids crying and miss their dad but he wont reply, I wanted him back desperately. we were in a very good couple and yet he just ignores me and get on with his life just like that, so i was looking for help after reading a post of Dr masako on the internet when i saw a lady name SHARRON testified that Dr masako cast a Pure love spell to stop divorce. and i also met with other, it was about how he brought back her Ex lover in less than 24 hours at the end of her testimony she dropped his email, I contacted Dr masako via email and explained my problem to Dr masako and he told me what went wrong with my husband and how it happen, that he will restored my marriage back, and to my greatest surprise my Ex husband came back to me, and he apologized for his mistake, and for the pain he caused me and my children. Then from that day our marriage is now stronger than how it was before, Dr masako you’re a real spell caster, you can also get your Ex back and live with him happily: Contact Email [email protected] or Call/whatsapp +2349047144277 Visit his Website: https://doctormasako2.wixsite.com/drmasakospelltemple

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ford chege
4/4/2025 12:44:23 am

I want to share my incredible experience with Dr. Dan’s herbal medicine. I had previously tried Melissa oil and Lavender Healing Herbs, but unfortunately, they didn’t produce significant results. However, after using Dr. Dan’s herbs, my herpes virus was completely cured. It’s been two years now, and I haven’t had any outbreaks or sores. I genuinely believe my herpes is permanently gone.

If you’re looking to permanently eliminate herpes, I highly recommend reaching out to Dr. Dan. You can contact him via WhatsApp at +447365758728 or email him at [email protected].

Don’t underestimate the powerful healing potential of herbs!

Répondre
Lucy
4/5/2025 07:28:14 pm

Even though I was reluctant to buy this product immediately because of fear and doubts, I eventually did and it worked for me. My herpes has been cured permanently and I was tested negative. I conducted the test severally after completing the medication and all test results read negative. It is one of the best decisions I have ever made, just give it a trial. You’re almost there” Contact Dr. Ogudugu on youtube today to also get your help and be free from any types of diseases and infections.Email [email protected] /WhatsApp +2348163026536.

Répondre
oiler James
4/12/2025 08:44:36 pm

I got cured miraculously from HPV Virus using herbs by Dr. Guba who sent me some herbal medicines and I used them as instructed within two weeks. Before I knew I was totally healed, I visited my doctor for a medical examination. Behold, I am negative. I introduced this great doctor to a couple of infected friends who also tried the medication and they were cured as well . Please if you have this virus and you have tried so many things or have been deceived severally, here is your final solution for you send him an email via: [email protected] or WhatsApp: + 234 816 238 8034 or website: https://drgubahealingherbs.wixsite.com/guba-healing-herbs

Répondre
Kristine Fishell
4/18/2025 01:00:31 pm

I have faced many challenges in my life, particularly financial ones. I have experimented with various jobs and business ventures but none seemed to be successful for me. As the saying goes, when you exhaust your options, you look for assistance. During my search for self-improvement, I came across someone sharing their gratitude towards Meduza, the renowned spell caster for helping them win the lottery. Initially, I had my doubts but I felt compelled to give it a shot since my life was falling apart. I contacted him for help, and he agreed to assist me with a prosperity spell. It took almost three days for him to complete the spell for me and after two weeks, I found myself among the fortunate winners of $1 MILLION from the Elon Musk give away. At this moment, I want to state that Meduza is the top spell caster I have discovered online and I would appreciate your support in expressing my immense gratitude to him via his email: [email protected] or WhatsApp +1 807 907-2687.

Répondre
Diana M Eklund
5/14/2025 05:47:43 pm

MY HERPES SIMPLEX CURE BY HERBAL MEDICINE..
It's Good for herpes patient to please read my testimony,my name is Diana i am from California USA, I caught genital herpes from my ex girlfriend who never had any symptoms. I have had it for 1 year now, and it has affected my life. I have told my boyfriends who I trusted about it and I have never had a bad reaction, it has affected my new relationships with Damon People think herpes is really a minor skin irritation,herpes has a long term effects on health.The stigma attached to this virus by ignorant people is ridiculous. Most people have herpes in one form or another. I would like to advise people on how i got rid of my herpes.i was reading a comment on the internet,and i saw a testimony posted by a woman from island that she got rid of her herpes with the help of dr. sikies .so i was so happy when i saw that post,that his herbal medication is free.i quickly collected the herbal doctor email: [email protected]
call or whatsapp him on his mobile number +2348163430143
Place order via website https://drsikiesherbalcuremedicine.weebly.com/
He also have the herb to cure
(1) CANCER,
(2) DIABETES,
(3) HIV&AIDS,
(4) URINARY TRACT INFECTION,
(5) CANCER,
(6) HERPES,
(7) BARENESS/INFERTILITY
(8) DIARRHEA
(9) ASTHMA...

Répondre
Stephanie Jane
5/22/2025 08:37:16 am

DO YOU WANT YOUR EX BOYFRIEND, GIRLFRIEND, WIFE OR HUSBAND BACK? I HIGHLY RECOMMEND YOU TO CONTACT DR BOB:TEXT /WHATSAPP : +2349153314547
EMAIL:[email protected]
Hello am STEPHANIE JANE from the united state, i read some testimony about Dr  Bob   on how he has helped people in bringing back there ex within 48hours i was just thinking if that was real, And decided to call a lady who made a testimony and also dropped her number, So i called her and ask her about Dr  Bob   she said Dr  Bob   is a trustworthy man and he his ready to bring back my lover for me, i was just so happy and a little bit relief that my lover will be back to me soon, Then i decided in contacting Dr  Bob   which i did, And before i could share him my problem he has already told me what i came for, And he said everything will be okay within 48hours that my lover will be back to my arms, So he said he would be casting the spell and that within 48hours my lover would call me, So i hoped so truly before the 48hours i got a call from a man who has left me for the past 1years saying he is sorry and he wants me back, i was happy and i said i also want him back, Then i traveled to Canada to meet him up,  And he apologized for what he has done to me now he proposed to marry me and we are both preparing for our wedding soon, All thanks to the great and World best spell caster.
WhatsApp him directly :+2349153314547
https://www.bark.com/en/us/company/dr-bob-forever-love-spell-cast-2023/b12Yk/?show_reviews=true

https://www.facebook.com/drbobsupernaturalspelltemple/

Répondre
Leticia Richmond
6/4/2025 10:53:09 pm

I bring you Good news.There is a man called Dr Guba a herbal practitioner who helped cure me from Genital herpes,this i had suffered from for the past 2years and i have spent so much money trying to survive from it.I got my healing by taking the herbal medicine he sent to me to drink for about 9days.3days after completion of the dosage,I went for a medical checkup and I was tested Genital Herpes NEGATIVE.I'm sharing this so that other people can know of this great healer called Dr Guba because I got to know him through a friend he cured from HIV.I was made to understand that he can cure several other deadly diseases and infections.Don't die in ignorance and don't let that illness take your life.Contact Dr Guba through his email [email protected] You can also call him or WhatsApp him on:+2348162388034 Thank you Dr. Guba. Be kind enough to share as you receive. or website: https://drgubahealingherbs.wixsite.com/guba-healing-herbs

Répondre
Athony Isak
6/6/2025 09:58:42 am

My heart is so filled with joy. If you are suffering from Erectile dysfunction or any other disease you can contact Dr. Moses Buba on this [email protected] or His website : https://www.facebook.com/profile.php?id=61559577240930 .website page https://bubaherbalmiraclem.wixsite.com/website
. For more information from me reach me via WhatsApp : +44 7375 301397

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Williams Jones link
6/18/2025 12:23:49 pm

HOW I RECOVERY MY LOST FUND THROUGH HACKERZED NEMESIS.

I want to sincerely thank Hackerzed Nemesis for the outstanding work they did. Initially, I was unsure if they would be able to recover my lost funds, but after patiently waiting for less than 24 hours, they successfully delivered the Everlast coins I lost to a fake company. Words cannot fully express my gratitude for their dedication and professionalism. Thank you so much, Hackerzed Nemesis, for your excellent work and for restoring my trust.

Contact info:
Whatsapp +1 (639) 395 4628
Email: [email protected]
Web: Hackerzednemesis.com

Répondre
sherry morse
7/11/2025 01:05:30 pm

I am profoundly grateful for your compassionate care and herbal treatment protocol that cured my herpes. Your holistic approach balancing herbs, lifestyle guidance, and emotional support was exactly what I needed. Throughout my treatment you held space for every question and concern, responding with clarity and kindness. Your unwavering belief in natural healing inspired me to believe in myself again. Now, free from outbreaks and anxiety, I feel empowered, confident, and alive. Your dedication to evidence-based herbal care is extraordinary and your commitment to my well-being was palpable. You didn’t just treat symptoms you addressed the root, guided my healing journey and celebrated each milestone with me. Thank you, Dr. Ademise, for restoring my health and hope. You truly are a remarkable healer and a blessing in my life. and to contact below

WEBSITE: drademise.wixsite.com/healinghome

YOUTUBE: Dr. Ademise

EMAIL: [email protected]

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