Recommendations for 6 countries from the 82nd PBF course in Cotonou

All participants successfully passed the post-test ! Congratulations

The last FBP course of 2019 took place in Cotonou from December 2 to 14, 2019 with 32 participants from six countries (Mali, Comoros, Gabon, Mali, Niger, DRC and CAR). Eight groups (three groups from CAR) developed excellent action plans, which, if they are implemented, will greatly advance PBF in the respective countries and sectors.

Here the detailed report of the course (rapport).


  • In the CENTRAL AFRICAN REPUBLIC around 50% of the population is covered with PBF, and the government decided to roll out to 100% the reforms nationwide by the end of 2020 with funding from the government, the World Bank and the European Union. NGOs such as Premiere Urgence Internationale – which attended the Cotonou course – may also start playing an active role. In the DEMOCRATIC REPUBLIC OF CONGO, the PBF reforms are progressing well and 40% of the population is covered by PBF. The designs in CAR and DRC are relatively “pure” in terms of the application of the PBF best practices. However, the participants from these two countries in Cotonou also propose several improvements in the design.
  • In the COMOROS, 50% of the country is covered with PBF and the country is proposing to scale up in 2021 towards a “purer” PBF design compared to the current one. The six participants in Cotonou in their action plan proposed several improvements in the design and will advocate for a larger ownership for PBF among key decision makers.
  • In GABON, the planning for performance-based financing started in early 2017 with Gabonese funding, but implementation has not yet started. This may be due to a lack of clarity on the financial procedures and willingness by government to provide the funds. The Ministry of Finance in Gabon aims to launch a pilot PBF program and could also help the Ministry of Health to progress with PBF.
  • MALI has experienced long delays in starting the scale up of PBF despite that two pilot projects have shown excellent results. Yet, the Mali government with support of the World Bank, the Dutch government and GFF now aim to start a large relatively “pure” PBF pilot in 2020 for 5.8 million people and a budget of $ 66 million for four years. A large team of 14 people from Mali was in Cotonou to improve the design of the program.
  • NIGER also experienced long delays in starting the scaling up of PBF despite that the pilot project has shown excellent results. The reasons for the delays are: 1. A lack of ownership for PBF by the decision-makers. PBF remained in the “project mode”; 2. Delays in the effective integration of the National Technical PBF Unit in the Ministry of Health; 3. Errors in the design of the PBF program. The Niger participants in Cotonou aim to revive PBF with the start of a large pilot programme.
  • In the Central African Republic, the MINISTRIES OF JUSTICE AND THE INTERIOR with support of Cordaid aim to launch a PBF program. Experience in other countries with PBF in these sectors such as in the DRC have shown good results.

Image de temple de pitons de Ouidah

A problem in many countries is that PBF budget lines are not effectively integrated in the government budget and Finance Law procedures.

There may be a lack of clarity regarding the financial and legal procedures required to disburse the government budget through performance payments directly towards peripheral providers and the population instead of through the classical complex input procedures

A further general problem is that in several countries some decision-makers are hesitant to transform the less-transparent input financing into results-based funding, which transmits money directly to providers and the population. The latter approach is more transparent and less likely to lead to corruption. The best way to remedy this is to offer performance contracts to the main actors and departments of the ministries of health and finance. This should enable them to obtain a competitive remuneration adequate to only defend the public interest instead of earning money through shady deals.

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Messages from Nigeria, Liberia, CAR and South Soudan

The 80th international PBF course organised by SINA health in Mombasa-Kenya in November 2019, welcomed 37 participants from Nigeria 19; Liberia 16; South Sudan 1; and CAR 1. Most were from the health sector. Hereby the detailed course report.

This course was evaluated by the participants as one of the best since 2007. The criteria methods and facilitation, participation and organisation scored very well with averages of respectively 95% 93%, and 94%. The final evaluation indicated that for 100% of the participants the content of the course related well to their professional activities and that the methodology of the course was excellent. Yet, 50% of the course participants also commented that the course was too short. Continue reading

The 80th PBF course in Cotonou with messages from 10 countries

The 39 participants to the PBF course in Cotonou

The 80th FBP course took place in Cotonou from June 17 to 29, 2019 with 39 participants with 10 countries represented. Hereby the detailed course report.


  • We report that in Burundi, Gabon, Mauritania, Ivory Coast, Cameroun, the Democratic Republic of Congo and the Central African Republic performance-based financing is advancing well.
  • Yet, delays of subsidy payments in Cameroon caused by factors not related to PBF has created serious problems.
  • There are prolonged delays in the scale up of PBF in Guinea Conakry and Madagascar and efforts to restart PBF in Benin have not yet been successful.
  • Yet, overall, when reviewing the results from these 10 countries, the balance is positive. Lessons learned are becoming available both from positive experiences but also from mistakes made.

The PBF course was successful in exchanging the above experiences and all the participants from in total 11 groups developed excellent action plans that are likely to advance PBF in the 10 countries represented. Continue reading

77th cours, financial procedures and emergency PBF

The 77th performance-based financing (PBF) course took place from Monday, May 13 to Saturday May 25, 2019.  Hereby the course report

                    The 51 participants of the 77th PBF course

The course welcomed a mixed group of 51 participants from the Ministry of Health, the Ministry of Finance, the National Civil Status Registration Office, the Ministry of Economy, Planning & Regional Development, and the Governors’ office of the West Region. All participants conducted the final exam. The overall score of the final test was 70% and eight participants obtained distinctions for their final exam with scores of 87% or more.

The status of PBF in Cameroon

By the end of 2019, 100% of the Cameroun population will be covered by performance-based financing and will be 10th low or middle income country to achieve this. 100% of the 2.7 million town of Douala is now under PBF with 80-90% of the contracts given to the private sector. Continue reading

National PBF scale-up in Cameroon – the 76th course

       We report on the PBF course, which took place in Douala from April 22 to May 4, 2019 with 58 participants from Cameroon. Hereby the detailed cours report (rapport du cours)

The 58 participants of the cours with national and regional authorities

This time there was a large delegation of 13 people from the Ministry of Finance with 8 financial controllers and 5 Treasurers General of Payments (TPG) from 6 regions. There were 8 economic and social advisors of the governors from 8 regions. The Ministry of Planning and the Department of Civil Registration (BUNEC) were represented and there were two independent participants. All other participants were from the health sector

The daily evaluations of the course showed an average score of 80%, which is 1 point higher than the average of the 44 previous French courses. The impact of the 76th PBF course was reflected in the good quality of the action plans proposed by the different groups and the general recommendations (see the rest of this report).

Fifty-nine participants (including one participant from BUNEC, who assisted as an observer) did the post-test and the average progression from the pre-test was 29%. The average post-test score was 68%, which is 4% lower than the 72% average of the last 20 courses. Nine participants obtained a certificate of distinction with a score of 87% or higher for the final course test. Six participants obtained a certificate of participation with scores of 50% or less.

The achievements of PBF in Cameroon

  • Towards the end of 2018, performance-based financing in Cameroon covered 78% of the population and it will reach 100% during 2019 ;
  • The liberalization of the pharmaceutical sector with the accreditation of pharmacies by the regulators has started to produce the results on improving the availability of medicines in certain regions such Littoral. This liberalization has also resulted in the increase of the health facility revenue rather than that these revenues benefit some monopolistic distributors. The health authorities in Littoral Region accredited 10 wholesale distributors in Douala and the other regions started the same accreditation process.
  • The contracting of the regional and district health authorities produces good results. It better focuses the authorities towards achieving their core activities such as quality control and accreditation of the health facilities and pharmacies. This for most authorities is a welcome move away from wasting their time on the inefficiencies that existed in the old system of input procedures without a clear vision or objectives ;
  • A health centre in the North region before PBF rehabilitation

    As an example of the positive effects of PBF for the availability of qualified staff in remote areas, Ngong and Guider health districts in the Northern Region reported an increase in the number of qualified personnel by 98% from 55 to 109 between 2017 and 2019. PBF has a positive impact on the migration of qualified personnel to vulnerable PBF health facilities.

  • Numerous PBF infrastructure improvements have been made as shown by the following images, pre- and post of Guider Health District in the Northern Region.

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