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Introduction
CHAPTER 6
The literature provides evidence of some gains in coverage and effective coverage from the introduction of performance-based financing (PBF), typically when compared with business-as-usual. However, these are not ordinarily the only two alternatives available to policy makers. When assessing the overall evidence on PBF interventions, a relevant question thus becomes, what are the policy alternatives or complements to PBF? As this chapter shows, many of the gains from PBF interventions become less salient when the impacts of other policy alternatives are considered. For instance, a growing body of high-quality evidence demonstrates the importance of approaches such as user-fee removal and engaging the local community in overseeing the local health facility, whether in combination with financial incentives on the supply side or alone (Falisse et al. 2014; Björkman and Svensson 2009). A demand-side alternative or complement to PBF may be cash transfers to patients or care seekers. Similarly, studies in Cameroon (de Walque et al. 2021) and the Kyrgyz Republic (Friedman and Kandpal 2021) examine the potential of supportive supervision. In Cameroon, additional financing, whether performance based or unconditional, drove program gains, but in the Kyrgyz Republic pilot (box 6.1), supervision, even without financial incentives, improved process quality, although health outcomes only improved in the PBF arm.
This chapter thus investigates the evidence on PBF’s impact relative to other key interventions designed to increase effective coverage in health. It first presents results from a systematic review and meta-analysis of demand- and supply-side financial incentives to increase the use of reproductive, maternal, and child health services. Next, the chapter conducts a detailed
