Performance-Based Financing Improves Health Facility Performance and Patient Care in DRC
In recent years, Democratic Republic of the Congo (DRC) has increasingly focused on strengthening its health system and improving health outcomes for its 79.8 million people. In 2006, through its Strategy for Reinforcing the Health System, the Ministry of Health began decentralizing the health sector and introduced an Essential Package of Health Services at health centers and referral hospitals to improve equitable access to reproductive, maternal, newborn, and child health (RMNCH) services.
Despite this progress and steady investment by foreign donors into the health system, access to quality health services remains limited, particularly among those living in hard-to-reach areas and the estimated 1.7 million persons internally displaced by conflict. Health facilities frequently lack essential drugs and commodities and there are not enough qualified health workers to effectively meet the population’s needs, especially in rural areas. With minimal domestic funding for health care, government health facilities rely on out-of-pocket payments by patients, which are considered a major barrier to accessing services.
Performance-based financing (PBF) is considered a key strategy for increasing the provision and quality of health services. Unlike traditional payment mechanisms, PBF directly rewards health care providers with financial incentives according to achieved results based on predetermined performance targets. The strategy has been used to strengthen health systems, improve provider and facility efficiency, and ensure accountability. Moreover, PBF can help to address common challenges among health care providers, including low motivation, insufficient empowerment, and attrition.