As far as low-income countries are concerned, the first applications of the Performance Based Financing (PBF) approach can be tracked back to the late nineties in pioneer countries such as Haiti and Cambodia. Over the next 20 years, the strategy has grown in popularity and has been adopted by an increasing number of countries. Some early adopters, like Rwanda or Burundi, rapidly transitioned from a pilot experience to a national policy. In some other countries, the adoption is much more recent, things are simply taking more time and in others RBF has failed to come on to the policy agenda.
The policy process through which a country moves from the idea to test RBF to a fully-fledged national policy is far from straight-forward. It is about developing a proof of concept, addressing national public health problems, gathering support among a large set of stakeholders, raising funds… So far, knowledge on how to overcome all these obstacles has not been systematized and synthesized.
When reflecting on the expansionary policy development of a RBF or PBF scheme, it is also important to put it into perspective. PBF is not an end in itself – it is a strategy to improve performance of the national health system, in terms of outcomes for the population, general efficiency and equity. Therefore, the issue of scale up must be understood in a broad sense: policy makers and analysts have to take into account the necessity to integrate the strategy in the broader effort to establish a coherent national health financing system as opposed to expanding a scheme as a narrowly focused intervention framed as an end in itself.
It is with this two main considerations in mind that the Alliance for Health Policy & Systems research spearheaded the research program “Taking Results Based Financing from scheme to system”. The research was carried out in 2015 by national teams from 11 countries: Armenia, Burundi, Cambodia, Cameroon, Chad, Kenya, Macedonia, Mozambique, Rwanda, Tanzania, Uganda. The program was funded by the Alliance for Health Policy and Systems Research supported by NORAD with technical support from a team based at the Institute of Tropical Medicine, Antwerp.
Many of you contributed to this process, as researchers or as key informants. Some of you have already heard about our findings at international conferences, in Dar-Es-Salaam, Harare, Rabat and Vancouver. But many of you are also active in countries not covered by the program or have missed our face-to-face events. There will be three channels to catch up. We of course recommend that you use these opportunities together: indeed they complement each other well.
We have agreed with Joël-Arthur Kiendébréogo and Nadège Ade, the editorial team of the CoP webinar series, to organize a series of webinars to present some key findings.
The first webinar will introduce the research program. It will be presented by the two scientific coordinators of the program (Zubin Shroff and myself). In this webinar, we will present the research program as a whole as well as the main lessons learnt.. Among other things, we will present the multi-dimensionality of scale-up (it is much more than covering the whole country!), we will propose to analyze any PBF scale-up as a process going through four main stages and provide an overview of barriers and facilitators for scaling up a RBF scheme. We believe that this is strategically useful information to all those of you directly or indirectly involved in the design, implementation and study of PBF schemes.
With 11 countries, we have potentially a large number of country cases to present. Our intention therefore is to organize a few webinars focusing on some country cases. The actual number of cases will partly depend on the interest observed at the first webinar.
We will schedule these different webinars in the weeks to come. Note that the first webinar (general presentation of the research program) is scheduled for January 18th 1-3 pm, GMT. It will be in French and you will have to connect here. The same content will be presented in English on January 20th (1-3 pm GMT as well).It will be here. We recommend you to save the dates in your agenda. For more detailed and up-to-date information, it is recommended to register to our PBF online forum.
As a reminder, a webinar consists of a 60-90 minute online session with a power point presentation and a discussion at the end. To participate, you will have to install the WebEx program on your computer and have a sufficiently good internet connection at the time of the session. More guidance is provided here. The webinar team is also ready to help those for whom it is the first WebEx webinar ever, but you must alert them in time. You contact them here.
The case studies carried out in the 11 countries provide a wide range of experiences. We have selected three interesting cases, at different points of the scale up process for illustration through policy briefs. They are about the story of Chad (where the PBF pilot project never transitioned to a national program), the experience of Cameroon (which had to transfer the purchasing capacity from external actors to regional semi-autonomous entities) and the full scale-up of Armenia (whose PBF program was integrated within a plan of Primary Health Care revitalization, including in it a non-communicable disease component). A fourth policy brief synthesizes the enablers and barriers to scale up identified from the review of ten country experiences.
These policy briefs will be officially published in the weeks to come. They will be introduced here on Health Financing in Africa. We hope that they will be useful materials for your own policy development or teaching.
Finally, we have agreed with the journal Health Systems and Reform to develop a supplement consisting of a series of papers presenting findings from our multi-country program. This is of course a venture demanding a bit more time, as papers have to go through a rigorous peer review process. We expect the first papers to be published in Spring 2017. We will of course keep you informed of their publication.