Using Performance-Based Financing to Improve Health Services
Organizations and countries throughout the world are increasingly using performance-based financing (PBF) to help make improvements in health and development. PBF links an organization’s funding to its achievement of agreed-upon targets and may include bonuses if the organization exceeds those targets. MSH has managed performance-based grants and contracts for health services on behalf of funding agencies and has also provided technical assistance to many governments, private organizations, and funding agencies to help them develop and implement their own performance-based initiatives.
This includes strengthening their ability to manage grants and contracts, estimate the cost of health services, set fees and performance indicators, and improve systems for health information, financial management, and accounting. On a worldwide front, MSH provides technical assistance to the Global Fund for AIDS, Tuberculosis, and Malaria and to countries in the design and implementation of the Global Fund’s performance-based grants processes. Current MSH activities in performance-based financing include:
- Haiti. MSH has been managing USAID-funded PBF programs in Haiti since 1999, and is currently doing so through the HS 2007 Project. The program works through 27 NGOs to provide basic health services to over 33 percent of the Haitian population.
- Rwanda. MSH manages USAID's flagship HIV/PBF Project which provides technical assistance to the Ministry of Health’s national PBF initiatives for funding the delivery of primary health care services in most of the country. The project also manages a grants program that funds HIV/AIDS and other key services.
- Guinea. Through the USAID-funded PRISM Project, MSH assists managers of mutuelles (community-based health insurance funds) and members of community committees to develop and implement performance-based agreements for local health insurance schemes. Access to services and quality of care has improved as a result, as has local-level governance.
- Afghanistan. As part of the REACH Project, MSH managed USAID’s performance-based grants program which channeled $16 million to 29 local and international NGOs, and—together with technical assistance and training—enabled the expansion of services for child health, maternal health, basic obstetric care, and family planning to 7.1 million people in 14 of Afghanistan's 34 provinces. Under the follow-on TECHSERVE Project, MSH continues to provide assistance to the Ministry of Public Health in managing the grants program.
- South Africa. MSH manages a performance-based grants program for USAID through the Integrated Primary Health Care (IPHC) Project that helps to establish and strengthen community-based NGOs providing HIV/AIDS services, support for orphans and other vulnerable children, and community home-based care. Through IPHC's predecessor, the EQUITY Project, MSH helped the National Department of Health develop performance-based contracts with local government and private provider groups.
- Malawi. As part of its USAID-funded Malawi Program, MSH is providing technical assistance to the Ministry of Health in the development and implementation of a performance-based contracting program through which the Christian Health Association of Malawi is funded to provide maternity services to the rural poor.
- Nicaragua. As part of its LMS Project, MSH provides technical assistance to the Ministries of Finance, Planning, and Family in developing a methodology for performance-based funding of government services.
Other MSH activities in performance-based financing have been carried out in the Philippines, Kenya, Uganda, and Madagascar.