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

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), Ni...

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Published in:	BMJ global health Vol. 3; no. 5; p. e001036
Main Authors:	Mayaka Ma-Nitu, Serge, Tembey, Lara, Bigirimana, Eric, Dossouvi, Christophe Y, Basenya, Olivier, Mago, Elizabeth, Mushagalusa Salongo, Pacifique, Zongo, Aloys, Verinumbe, Fanen
Format:	Journal Article
Language:	English
Published:	England BMJ Publishing Group LTD 01-09-2018 BMJ Publishing Group
Subjects:	Global health Health care policy Knowledge Burundi Cameroon Burkina Faso United States > US Africa Rwanda Zimbabwe Nigeria Sub-Saharan Africa performance based financing health policy health economics
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Summary:	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). The PBF approach has been improved by several African countries, with innovations coming from the DRC (a tool for a fair and transparent sharing of performance bonuses), Rwanda (community verification),5 Cameroon (household visits according to protocol and urban PBF),6 Burundi (coupling PBF with exemption of user fees),7–9 Burkina Faso (PBF with special focus on indigents, PBF with mutual health insurance), Nigeria (coupling PBF with demand-side financing approaches) and most recently Zimbabwe (risk-based verification to reduce administrative costs). [...]using a health policy framework, such as Kingdon’s multiple streams framework,11 and collecting primary data would have been beneficial for Paul et al’s analysis of the conditions of emergence in our countries.2 They would have appreciated the part that the ‘problem stream’ (the crises or failures observed in our health systems) played in this development at country level. Integration into national processes also occurred in academia—the University of Zimbabwe now runs an international PBF course, which is practically designed for African contexts.16 However, we do not deny that PBF expansion benefited from the financial and technical leadership developed by the World Bank and other global health actors.17 But PBF is not the only strategy with such a partially exogenous origin—the Millennium Development Goals, the Sustainable Development Goals and the UHC agenda are all initiatives designed and promoted by external influences before they flourish in Africa.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 ObjectType-Commentary-3 content type line 23
ISSN:	2059-7908 2059-7908
DOI:	10.1136/bmjgh-2018-001036