Performance-Based Financing, Basic Packages of Health Services and User-Fee Exemption Mechanisms: An Analysis of Health-Financing Policy Integration in Three Fragile and Conflict-Affected Settings

Eelco Jacobs (), Maria Paola Bertone, Jurrien Toonen, Ngozi Akwataghibe and Sophie Witter
Additional contact information
Eelco Jacobs: Royal Tropical Institute (KIT)
Maria Paola Bertone: ReBUILD and Institute for Global Health and Development, Queen Margaret University
Jurrien Toonen: Royal Tropical Institute (KIT)
Ngozi Akwataghibe: Royal Tropical Institute (KIT)
Sophie Witter: ReBUILD and Institute for Global Health and Development, Queen Margaret University

Applied Health Economics and Health Policy, 2020, vol. 18, issue 6, No 7, 810 pages

Abstract: Abstract Background As performance-based financing (PBF) is increasingly implemented across sub-Saharan Africa, some authors have suggested that it could be a ‘stepping stone’ for health-system strengthening and broad health-financing reforms. However, so far, few studies have looked at whether and how PBF is aligned to and integrated with national health-financing strategies, particularly in fragile and conflict-affected settings. Objective This study attempts to address the existing research gap by exploring the role of PBF with reference to: (1) user fees/exemption policies and (2) basic packages of health services and benefit packages in the Central African Republic, Democratic Republic of Congo and Nigeria. Methods The comparative case study is based on document review, key informant interviews and focus-group discussions with stakeholders at national and subnational levels. Results The findings highlight different experiences in terms of PBF’s integration. Although (formal or informal) fee exemption or reduction practices exist in all settings, their implementation is not uniform and they are often introduced by external programmes, including PBF, in an uncoordinated and vertical fashion. Additionally, the degree to which PBF indicators lists are aligned to the national basic packages of health services varies across cases, and is influenced by factors such as funders’ priorities and budgetary concerns. Conclusions Overall, we find that where national leadership is stronger, PBF is better integrated and more in line with the health-financing regulations and, during phases of acute crisis, can provide structure and organisation to the system. Where governmental stewardship is weaker, PBF may result in another parallel programme, potentially increasing fragmentation in health financing and inequalities between areas supported by different donors.

Date: 2020
References: View references in EconPapers View complete reference list from CitEc
Citations: View citations in EconPapers (1)

Downloads: (external link)
http://link.springer.com/10.1007/s40258-020-00567-8 Abstract (text/html)
Access to the full text of the articles in this series is restricted.

Related works:
This item may be available elsewhere in EconPapers: Search for items with the same title.

Export reference: BibTeX RIS (EndNote, ProCite, RefMan) HTML/Text

Persistent link: https://EconPapers.repec.org/RePEc:spr:aphecp:v:18:y:2020:i:6:d:10.1007_s40258-020-00567-8

Ordering information: This journal article can be ordered from
http://www.springer.com/economics/journal/40258

DOI: 10.1007/s40258-020-00567-8

Access Statistics for this article

Applied Health Economics and Health Policy is currently edited by Timothy Wrightson

More articles in Applied Health Economics and Health Policy from Springer
Bibliographic data for series maintained by Sonal Shukla () and Springer Nature Abstracting and Indexing ().