Phase: Pilot PBF programs started in 2 provinces in 2011
Coverage Estimate: 10%
Supported by: USAID; CDC, EGPAF; Abt Assoc
Description: EGPAF started PBF based on the Rwanda model in January 2011. The main aim was to address: MOH capacity to respond to health needs, improve the responsiveness of the HC System by improving autonomy and improve equity of health care service geographic distribution. The pilot was implemented in Gaza and Nampula Provinces and involved 52 health centers and hospitals. In 2012, CHASS started in PBF in two other districts, in Manica province.
There are a number of challenges in the PBF design in Mozambique and the feasibility score is 62%:
- No complete autonomy (HF do not have the right to hire and fire staff);
- PBF program should cover the full primary level and hospital packages, and not be restricted to HIV indicators;
- The separation of functions is not complete (notably between payments and verification)
An impact study conducted by CDC and published in 2017 showed the following results :
PBF is an effective strategy for driving down the HIV epidemic and advancing primary care service delivery than input financing alone. Our study did not find any negative effects of PBF vis-à-vis pure input financing, nor did we observe spill-over effects (positive or negative) in the examined non-PBF indicators. Thus, large-scale external financing programs in Mozambique should consider adopting an output-based model, tailored to each provincial context. That being said, the fact that some indicators were not responsive shows that PBF is not a silver bullet. Rather, this study highlights the essential need for policymakers to carefully examine their own contexts to determine whether PBF could be an effective solution relative to other health system and financing mechanisms.
Health Policy Plan. 2017 Dec; 32(10): 1386–1396. The effect of a performance-based financing program on HIV and maternal/child health services in Mozambique—an impact evaluation. Yogesh Rajkotiaet al