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Performance-Based Financing, Basic Packages of Health Services and User-Fee Exemption Mechanisms: An Analysis of Health-Financing Policy Integration in Three Fragile and Conflict-Affected Settings

Author

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  • Eelco Jacobs

    (Royal Tropical Institute (KIT))

  • Maria Paola Bertone

    (ReBUILD and Institute for Global Health and Development, Queen Margaret University)

  • Jurrien Toonen

    (Royal Tropical Institute (KIT))

  • Ngozi Akwataghibe

    (Royal Tropical Institute (KIT))

  • Sophie Witter

    (ReBUILD and Institute for Global Health and Development, Queen Margaret University)

Abstract

Background As performance-based financing (PBF) is increasingly implemented across sub-Saharan Africa, some authors have suggested that it could be a ‘stepping stone’ for health-system strengthening and broad health-financing reforms. However, so far, few studies have looked at whether and how PBF is aligned to and integrated with national health-financing strategies, particularly in fragile and conflict-affected settings. Objective This study attempts to address the existing research gap by exploring the role of PBF with reference to: (1) user fees/exemption policies and (2) basic packages of health services and benefit packages in the Central African Republic, Democratic Republic of Congo and Nigeria. Methods The comparative case study is based on document review, key informant interviews and focus-group discussions with stakeholders at national and subnational levels. Results The findings highlight different experiences in terms of PBF’s integration. Although (formal or informal) fee exemption or reduction practices exist in all settings, their implementation is not uniform and they are often introduced by external programmes, including PBF, in an uncoordinated and vertical fashion. Additionally, the degree to which PBF indicators lists are aligned to the national basic packages of health services varies across cases, and is influenced by factors such as funders’ priorities and budgetary concerns. Conclusions Overall, we find that where national leadership is stronger, PBF is better integrated and more in line with the health-financing regulations and, during phases of acute crisis, can provide structure and organisation to the system. Where governmental stewardship is weaker, PBF may result in another parallel programme, potentially increasing fragmentation in health financing and inequalities between areas supported by different donors.

Suggested Citation

  • Eelco Jacobs & Maria Paola Bertone & Jurrien Toonen & Ngozi Akwataghibe & Sophie Witter, 2020. "Performance-Based Financing, Basic Packages of Health Services and User-Fee Exemption Mechanisms: An Analysis of Health-Financing Policy Integration in Three Fragile and Conflict-Affected Settings," Applied Health Economics and Health Policy, Springer, vol. 18(6), pages 801-810, December.
    • Handle: RePEc:spr:aphecp:v:18:y:2020:i:6:d:10.1007_s40258-020-00567-8
    DOI: 10.1007/s40258-020-00567-8
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    References listed on IDEAS

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    1. Maria Paola Bertone & Jean-Benoît Falisse & Giuliano Russo & Sophie Witter, 2018. "Context matters (but how and why?) A hypothesis-led literature review of performance based financing in fragile and conflict-affected health systems," PLOS ONE, Public Library of Science, vol. 13(4), pages 1-27, April.
    2. György Bèla Fritsche & Robert Soeters & Bruno Meessen, 2014. "Performance-Based Financing Toolkit [Boîte à outils : Financement basé sur la performance]," World Bank Publications - Books, The World Bank Group, number 17194.
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    As found by EconAcademics.org, the blog aggregator for Economics research:
    1. Chris Sampson’s journal round-up for 28th December 2020
      by Chris Sampson in The Academic Health Economists' Blog on 2020-12-28 12:00:00

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    Cited by:

    1. Augustine Asante & Wilson S. K. Wasike & John E. Ataguba, 2020. "Health Financing in Sub-Saharan Africa: From Analytical Frameworks to Empirical Evaluation," Applied Health Economics and Health Policy, Springer, vol. 18(6), pages 743-746, December.

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