Results Based Financing: the health system perspective – a regional workshop

August 2015
Jo Borghi, Gemini Mtei, Ottar Maestad, Bruno Meessen

Many experts see the introduction of results based financing (RBF) schemes as an opportunity to strengthen, or even reform, health systems; however, they are also a potential source of new risks and challenges that are not well understood. A group of actors have joined forces to organize a three-day scientific workshop that aims to bring together the latest knowledge on the health systems effects of RBF with practitioners’ experiences of scaling-up these schemes in sub-Saharan Africa. The event will take place in Bagamoyo, Tanzania from November 24-26th  2015. 


Results Based Financing (RBF) – also known as Performance Based Financing (PBF) or Payment for performance (P4P) – involves the payment of financial rewards to health facilities or health workers based on their achievement of performance targets. In low income settings, the introduction of such schemes often coincides with broader system-wide changes to improve the quality and/or coverage of health services. Whilst there is an important body of research dedicated to evaluating the impact of RBF at population level, far less is known about the way these outcomes are achieved and the effects of RBF schemes on the health system. Yet, for countries, their partners and other stakeholders, identifying, measuring and understanding the health system level effects is of critical importance, as it would allow them to identify and correct for potential unintended consequences, and ensure that RBF offers a sustainable, and cost-effective solution to strengthen health systems. 

There are also key questions in terms of policy processes. Many countries begin by implementing RBF on a pilot basis with external funding, then the scheme progressively expands its coverage and eventually it is fully integrated in the public system (budget, national plan, and regulatory frameworks). This process is often not straightforward; reality often differs from what was anticipated and varies across contexts. So far, these policy processes have not been well documented either. Previously policy makers already expressed their need for guidance on how to manage the changes required to integrate RBF within a national health system. This requires sharing of experience and evidence.  

It is against this background that the Tanzanian Ministry of Health and Social Welfare, the Ifakara Health Institute, the London School of Hygiene & Tropical Medicine, the Institute of Tropical Medicine (Antwerp), the Chr. Michelsen Institute (CMI, Bergen) and the Performance Based Financing Community of Practice have decided to join forces to organize three days of activities in Bagamoyo, Tanzania from November 24-26th 2015.

Overview of the workshop

The aim of the workshop is to synthesise evidence on the health systems effects of RBF (and how to measure these), and on implementation issues when moving from pilot to policy, and identify implications for scheme design and technical capacities at country level. The program will be put together in such a way as to maximize discussion and learning and encourage the identification of priorities for future research, collective learning and policy action.

Days 1 and 2 will focus on the dissemination and discussion of findings on the health system effects of RBF in Tanzania and the wider region and the experience of integrating RBF into the health system. Key policy issues will be identified. Day 3 will be dedicated to reviewing research methods to identify and measure the health system effects of RBF; a study tour of a P4P scheme in Tanzania will also be proposed.

The three-day program will balance contributions by guest speakers and studies presented by researchers selected on the basis of submitted abstracts. 

Can I participate?

To allow for in-depth discussion, the number of participants will be limited, especially on days 2 and 3. The event will be in English.  

Workshop participants will be: (1) researchers involved in evaluating the effects of RBF schemes on the health system in Sub-Saharan Africa with empirical findings or methodological reflections on measuring health system effects; (2) researchers involved in analyzing the scale-up of RBF from scheme to system in Sub-Saharan Africa; (3) and policy makers, practitioners and donors involved in implementation of RBF and/or scheme financing in the region.  

If you belong to groups 1 or 2, you can send an abstract to pbf [dot] cop [at] gmail [dot] com; please respect the standard format: title; name and affiliation of the speaker; names and affiliations of co-investigators; a summary (of 300 words maximum with a clear description of your research method). We welcome frameworks, and early and final empirical findings. Both quantitative and qualitative research are welcome. The deadline for submission is September 18th 2015, midnight GMT. Key criteria for selection will be: originality and quality of the research and its relevance to the workshop theme. Applicants will be informed by September 28th. 

For the non-scientific participants (group 3), please note that we will prioritize the participation of experts working in Eastern and Southern Africa. Registration will begin around early October. A draft program will be available by then.

The workshop is supported by the RESYST Consortium, Global Health and Vaccine Research (Globvac) and the Belgian Development Cooperation. This will allow us to support the participation of invited speakers (if there is no alternative on their side) and researchers selected on the basis of their abstracts. Others will have to cover their own participation costs. The estimated cost of a three-day stay in Tanzania will be communicated when registration starts. 

Pay for Performance (P4P)