ReviewBMJ global health2018
Performance-based financing in low-income and middle-income countries: isn't it time for a rethink?
Review in BMJ global health, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 74 papers, 3 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
74 citing papers in PubMed, 3 syntheses or guidelines pooled it.
- Institutional financial incentives in healthcare: a review of normative considerations.BMC medical ethics · 2025Pooled it
- A systematic review of the effect of performance-based financing interventions on out-of-pocket expenses to improve access to, and the utilization of, maternal health services across health sectors in sub-Saharan Africa.Journal of global health · 2023Pooled it
- Factors That Influence Data Use to Improve Health Service Delivery in Low- and Middle-Income Countries.Global health, science and practice · 2020Pooled it
- Decentralized facility financing versus performance-based payments in primary health care: a large-scale randomized controlled trial in Nigeria.BMC medicine · 2021Trial
- A pilot study of a novel, incentivised mHealth technology to monitor the vaccine supply chain in rural Zambia.The Pan African medical journal · 2019Trial
- Unpacking the Role of Financial Incentives in the Motivation and Individual Performance of Nurses in LMICs: A Scoping Review Protocol.Public health challenges · 2026Review
- Making experts accountable in global health.BMJ global health · 2026Article
- A decision-tree model to evaluate the impacts of workforce investments aimed at strengthening emergency obstetric and neonatal care (EmONC) facilities in Burundi.Cost effectiveness and resource allocation : C/E · 2026Article
- Counter-verification in performance-based financing: key insights from the Côte d'Ivoire experience.Global health action · 2025Article
- Enhancing the role of innovative financing in global health.Global health research and policy · 2025Article
- Strengthening hospital infrastructure in a war context: the case of the Mopti regional hospital.Globalization and health · 2025Article
- Factors associated with overreporting based on community verification results in a performance-based financing program in Zimbabwe.BMC health services research · 2025Article
- Global strategies for implementing health financing equity - a state-of-the-art review of political declarations.International journal for equity in health · 2025Review
- Reducing fragmentation of primary healthcare financing for more equitable, people-centred primary healthcare.BMJ global health · 2025Article
- A results to action framework for community verification: A case study from a performance based financing program in Zimbabwe.PLOS global public health · 2025Article
- Effects of financial compensation structures on community health worker performance, motivation, and retention: evidence from a multi-arm quasi-experiment in Uganda.Frontiers in health services · 2025Article
- Closing the gap? Results-based financing and socio-economic-related inequalities in maternal health outcomes in Zimbabwe.Health policy and planning · 2024Article
- Reorienting health systems towards Primary Health Care in South Asia.The Lancet regional health. Southeast Asia · 2024Review
- Sustaining essential health services in Lao PDR in the context of donor transition and COVID-19.Health policy and planning · 2024Article
- External influences over Senegalese health financing policy: delaying universal health coverage?Health policy and planning · 2024Article
14 more citing papers are in PubMed but not listed here.
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Authors and funding
24 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
This paper questions the view that performance-based financing (PBF) in the health sector is an effective, efficient and equitable approach to improving the performance of health systems in low-income and middle-income countries (LMICs). PBF was conceived as an open approach adapted to specific country needs, having the potential to foster system-wide reforms. However, as with many strategies and tools, there is a gap between what was planned and what is actually implemented. This paper argues that PBF as it is currently implemented in many contexts does not satisfy the promises. First, since the start of PBF implementation in LMICs, concerns have been raised on the basis of empirical evidence from different settings and disciplines that indicated the risks, cost and perverse effects. However, PBF implementation was rushed despite insufficient evidence of its effectiveness. Second, there is a lack of domestic ownership of PBF. Considering the amounts of time and money it now absorbs, and the lack of evidence of effectiveness and efficiency, PBF can be characterised as a donor fad. Third, by presenting itself as a comprehensive approach that makes it possible to address all aspects of the health system in any context, PBF monopolises attention and focuses policy dialogue on the short-term results of PBF programmes while diverting attention and resources from broader processes of change and necessary reforms. Too little care is given to system-wide and long-term effects, so that PBF can actually damage health services and systems. This paper ends by proposing entry points for alternative approaches.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.