09 Oct 2013
The Government of Lesotho’s Ministry of Health took a conscious decision to adopt Performance-Based Financing (PBF) as an approach to finance and bolster its efforts to meet the three health Millennium Development Goals, i.e. reduce child mortality (goal 4), improve maternal health (goal 5) and combat HIV/AIDS, malaria and other communicable diseases (goal 6). PBF approaches have been especially successful in improving access to curative services, and increasing the uptake of preventive services such as vaccination of children and pregnant mothers, voluntary counseling and testing for HIV, institutional deliveries and the use of modern family planning methods. Whilst increasing the volume of services, PBF also increased the quality of these services considerably.
The various linkages between the project components, sources of funds, implementation modalities and structures are well articulated in this Project Implementation manual (PIM).
Results Based Financing and Performance Based Financing defined
Results-Based Financing (RBF) is any program that rewards the delivery of one or more health outputs or outcomes through financial incentives, upon verification that the agreed-upon result has actually been delivered. It encompasses the entire family of incentive approaches, both on the supply-side, and on the demand-side. PBF is a supply-side RBF providing incentives to only providers (facilities or individuals) and not to beneficiaries.
Although PBF approaches differ, they tend to have certain elements in common, they:
- link health financing to health care outputs and their quality;
- promote managerial autonomy and decision making rights on resources utilization;
- use non-governmental agencies for a purchaser role or management support; and
- enhance HMIS (Health Management Information System), monitoring and evaluation.
In the PBF approach, regulation, planning and quality assurance are provided by the regulator, in this case the MOH also defines output, quality and equity targets with indicators. The regulator also establishes and oversees adherence to rules and regulations. The purchaser sets targets and buys results from health service providers. The provider in specific geographic catchment area is responsible for developing innovative strategies and implementing activities that will improve the volume and quality of services and achieve the agreed-upon health targets or goals efficiently. In the case of Lesotho, Performance Purchasing Technical Assistance firm (PPTA) will provide critical support to all functions and will build capacity for respective entities at national, district and community levels.
Purchaser-Provider Split in the Lesotho MNH-PBF Approach