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What is RBF? A paradigm shift for health systems in low-income countries

What is RBF? A paradigm shift for health systems in low-income countries. Cape Town – 30 th September 2014 Bruno Meessen , Institute of Tropicale Medicine, Antwerp & Lead facilitator of the PBF Community of Practice. Observation 1: Health: outcome of a co- production process.

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What is RBF? A paradigm shift for health systems in low-income countries

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  1. What is RBF?Aparadigm shift for health systems in low-income countries Cape Town – 30th September 2014 Bruno Meessen, Institute of Tropicale Medicine, Antwerp & Lead facilitator of the PBF Community of Practice

  2. Observation 1:Health: outcome of a co-productionprocess

  3. Observation 2:It is aboutbehaviors – incentive matters Source: Bertone & Meessen 2013

  4. Different RBF strategies Performance BasedFinancing Cash on delivery Conditional cash transfer Voucher for CSW

  5. PBF: anAfricancommunity of experts • A virtual group of 1,500+ experts

  6. PBF: anAfrican agenda Countries will : “Improve efficiency in health systems (…) including the introduction of measures such as results based financing (RBF) and incentives to enhance transparency and performance and reduce wastage” (Tunis Declaration, 2012)

  7. PBF = a reform of provider payment • $1,080 available for: • Health facility operation costs (supplies, maintenance, outreach etc) – about 40% of funds • Performance bonus to health workers – about 60% of funds

  8. … but alsodarestoreform the health sector

  9. PBF is about efficiency Efficiency : • Allocativeefficiency: Funding is targeted on cost-effective interventions • Technical efficiency: strong incentive for greater effort, better management, innovation. • Transactional efficiency: concern forlow transaction costs (eg. direct transfer to health facilities).

  10. PBF improves equity & accountability But can also improve • equity: • formulato target specificgroups (e.g. Burundi) or geographicalareas. • transparency and accountability: • Stress on verification • Possible to benchmark performance • Transparency of funding flows

  11. PBF – manyspill-over effects • Real SWAp • Public finance reform • Public sector reform • New approach todecentralisation in the health sector • Integration of the private sector • New ecosystemenhancingeffectiveness of otherinterventions

  12. Conclusion PBF = a health system strengtheningstrategyfocused on results.

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