- Start: 2011, followed by three phases
- National coverage: 55%
- Feasibility score: 56%
- Beneficiaries: 9 million
The development of PBF (Performance-Based Financing) took place in four main phases:
2011–2013 Pilot projects in 8 health districts
2017–2019 PRSSMI project funded by the World Bank
2022–2026 PRPSS project in 8 provinces
2024–2026 Expansion to 12 provinces, covering approximately 55% of the population
The PRPSS, funded by the World Bank with USD 256.5 million (including USD 16.5 million from the GFF), currently constitutes the main national PBF intervention aimed at improving access to, utilization of, and quality of maternal, neonatal, and child health services.
Coverage: 1,377 contracted health facilities across 12 provinces, serving 9 million beneficiaries. The program facilitated 967,465 assisted deliveries, vaccinated 885,000 children, and recruited 1,805 contract staff.
An evaluation examined indicator trends across the 12 PBF provinces compared to 2 control provinces over three consecutive years, from July 2022 to December 2024.
Evaluation results (conducted by the WHO and funded by the World Bank; December 2026)
- Performance-Based Financing has significantly improved the coverage, quality, and equity of health services. Nineteen (19) out of 27 indicators show a statistically significant positive effect, particularly regarding maternal health, vaccination, and community services.
- Quality improved by between 14% and 36%.
- Health facilities supported by the PRPSS possess higher-quality infrastructure.
- State-certified nurses are present in 82.6% of project-supported health centres, compared with 66.5% in control centres. Similarly, 47.5% of PBF centres have at least one state-certified midwife, compared to only 11.8% in non-supported provinces.
- The availability of the basket of 20 essential medicines and other medical products is significantly better in PBF facilities: 85.2% of centres compared to 67.5% in control facilities.
- User satisfaction is markedly higher in PBF provinces: 62.1% compared to 40% in control provinces.
This success was achieved with a low feasibility score of 56%, showing that results could be even more significant if Chad’s PBF program design were improved. For details on the feasibility score, consult the report from the July 2026 PBF course in Cotonou (rapport du cours).
The PBF program’s gains in Chad remain fragile, as also shown by the low feasibility score. Serious disbursement delays, reliance on external funding, and persistent disparities between provinces remain, and a few indicators remain more favorable in the control provinces, which need further study. Sustaining these achievements requires institutionalizing PBF and transitioning to sustainable domestic financing.
