How many countries and people benefit worldwide from PBF – RBF in 2019?

This posting describes the status of PBF, RBF or strategic purchasing (a term preferred by WHO) worldwide.

It is possible that some information in this posting may not be correct, that it is outdated or that we excluded countries that do apply PBF or performance-type reforms.

We would highly appreciate if those, with more information or corrections about the current situation, would drop an email  to

Please consult the country overviews on this website that presents the countries in alphabetical order.

Our findings are based on the feedback from the participants to previous PBF courses and we consulted World bank Project Appraisal Documents of the World Bank as well as other publications available in the public domain.


  • In 9 countries (17%) PBF has become national policy. From those Cameroun and Burundi have the most “PBF pure” designs.

  • In four countries PBF is national policy but without national coverage (DRC, CAR, Argentina and Zimbabwe).
  • In 21 countries (35%) there are serious pilots or there is a process of scaling up towards national policy or there will be a restart (Congo Brazzaville).
  • In six countries (11%), PBF programs are in the process of preparation.
  • In six countries (11%), there were PBF pilots or initiatives but it is not clear (to us) what their governments aim to do next.
  • Two countries (4%) stopped their PBF programme: Benin (in 2017) and Indonesia (in 2009). We understand that there are discussions in Benin to restart. In Indonesia, the pilot was a small NGO initiative that did not reach the attention of national authorities. PBF or RBF in Asian countries is currently more active in the education sector, which may encourage the health sector to follow.
  • Nine South Saharan Africa countries (17%) have not yet considered PBF type reforms of which the largest are South Africa and Sudan and seven countries with relatively smaller populations. The absence from PBF-type reforms in South Africa is surprising and it would be great if somebody could clarify this.

We estimate that in 2019 there are 268 million beneficiaries to PBF or RBF schemes worldwide and that in 2019 $ 756 million has been committed to PBF.

When did countries start PBF?

  • Seven countries (15%) spearheaded PBF in Africa, Asia, and Europe from 1998 onwards. Rwanda was the early PBF champion in Africa and was studied by many other countries.
  • During 2006-2010, 8 countries started pilots
  • 24 countries (53%) started PBF initiatives between 2011 and 2015.
  • Seven countries (16%) joined from 2016 onwards.


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