Towards constructive rethinking of PBF: perspectives of implementers in sub-Saharan Africa

Serge Mayaka Ma-Nitu,1 Lara Tembey,2 Eric Bigirimana,3 Christophe Y Dossouvi,4 Olivier Basenya,5 Elizabeth Mago,6 Pacifique Mushagalusa Salongo,7 Aloys Zongo,8 Fanen Verinumbe9
To cite: Mayaka Ma-Nitu S, Tembey L, Bigirimana E, et al. Towards constructive rethinking of PBF: perspectives of implementers in sub-Saharan Africa. BMJ Glob Health 2018;3:e001036. doi:10.1136/ bmjgh-2018-001036

Summary box

As implementers of Performance Based Financing (PBF) in various countries in Africa, we have seen first-hand its benefits—but we acknowledge that there are challenges that require ongoing improvements, and that debates and critical analyses are opportunities to both question and strengthen the PBF approach.
► However, constructive debates must be based on facts, value the large set of experiences and require that all parties listen attentively and objectively to the arguments of stakeholders, especially those with local knowledge and diversified institutional affiliations.
► Notably, PBF was initiated in Rwanda, jointly by African and European experts—but we acknowledge that in our countries, PBF benefits from financial and technical leadership by the World Bank and other exogenous actors, and while exogeneity can raise problems, this is far from axiomatic.
PBF is an evolving strategy, with innovation and amendments by national actors based on their context—in Democratic Republic of Congo (a tool for a fair sharing of bonuses), Rwanda (community verification), Cameroon (urban PBF), Burundi (exemption of user fees), Burkina Faso (focus on indigents), Nigeria (coupling PBF with demand-side financing approaches) and Zimbabwe (risk-based verification to reduce administrative costs).
► We see the value of PBF in its system-wide effects, such as improving coordination, decentralisation accountability and overall governance in the health system (including community engagement in health system governance), and completeness and timeliness of health information system data.