The NEXT 97th PBF COURSE will be organized in COTONOU, November 17-19th, 2025. Hereby the announcement  (annonce) and the application form (fiche inscription) 

The 96th international course, held from June 30 to July 12 in Cotonou, was a success, with 37 participants from six countries. The largest group was from Mauritania (18), followed by Guinea-Bissau (7), Madagascar (5), Mali (4), Benin (1), and the DRC (1).

The course differed from previous ones in that the facilitation team provided early feedback on the groups’ action plans from the very beginning. This enabled the groups to modify and improve the quality of their action plans up to four or five times.

Hereby the full course report (rapport).

This was the third PBF course, held in seven months (December 2024, January 2025, and July 2025), which indicates that the PBF reforms are again attracting a growing interest in the ten African countries in attendance at the courses. This is also due to the hard work of several African experts and consultants of the World Bank and Cordaid, as well as the Dutch Embassy in Bamako. There were 75 participants in the three courses, and PBF is again seen as a credible, if not the best, approach to achieving universal health coverage. We estimate that currently fifteen countries in Africa implement PBF, including around five in the education sector.

1 Guinea-Bissau

Guinea-Bissau is in the PBF start-up phase. It is essential to establish the PBF National Technical Unit (CTN) directly under the Secretary General, with a strong coordinator who is familiar with PBF, who is a leader, along with 1-2 PBF experts.

A Contracting and Verification Agency could be contracted directly under the legal umbrella of an existing structure. This structure could be social or administrative and could also benefit from a support contract to avoid conflicts of interest. This approach could avoid the enormous delays in establishing the LCA, as was the case in Nigeria and Niger.

The examples of Mali and Mauritania could inspire Guinea-Bissau in this regard. The group also produced an action plan detailing the measures to take to achieve a PBF feasibility score of at least 80% for the PBF pilot phase. It requires exemptions from the existing laws and procedures to allow the autonomy of health centers, access to competing drug distributors, and investment support through the quality improvement bonuses. It is also necessary to ensure sufficient funding of at least USD 4.00 per capita per year. The most important thing for the country will be to launch PBF as soon as possible.

2           Madagascar

Madagascar has already conducted three pilot projects with PBF since 2018. These projects have produced encouraging results. However, these approaches had a “PBF purity” feasibility score of only 46%, which prevented a sustainable, high-quality, and efficient approach. The group developed a plan with specific recommendations aimed at achieving a purity score of at least 80%.

The most critical elements are:

• Develop a single PBF manual that covers both targeted free health care for vulnerable populations and generalized free health care for children and women in labor, rather than launching two separate manuals and projects.
• Attach the CTN to the General Secretariat to enable coordination of activities with other departments and programs in the Ministry of Health.
• Reduce the delays in the payment of PBF subsidies by creating a more efficient payment system.
• Include the participation of private health facilities.
• Add indicators to provide comprehensive packages for primary and secondary education instead of just specific indicators.
• Apply equity instruments for vulnerable populations.
• Map and divide health care areas.
• Conduct a baseline study.
• Liberalize the pharmaceutical market for health facilities so that they have access to accredited drug distributors (public and private). To this end, the pharmacy inspection system must be strengthened, rather than being dependent on a monopolistic central purchasing agency.

An institutional framework with contractual, hierarchical, and financial relationships was also produced during the course. Implementing the above recommendations will undoubtedly promote the success of PBF in Madagascar, particularly in the face of the poor health situation, as demonstrated in the Ihorombe Region, with demotivated staff, a lack of funding for health facilities, and outdated equipment.

3           Mali

None of the four participants in the Mali group currently works in PBF programs.

The two representatives of the National Institute of Social Security (INPS) have developed an excellent action plan to integrate some aspects of PBF into their organization. All 15 INPS health facilities have a centralized, input-based approach, and no head physician is responsible for authorizing expenditures. The health facilities experience supply shortages of between 100 and 180 days. The team proposes testing the PBF approach in two INPS pilot centers before gradually expanding it to other health facilities.

Cordaid in Mali started a PBF pilot in the education sector in two municipalities of Koulikoro with a local partner. The Cordaid representative Dr. Awa Sidibe also proposes introducing PBF into humanitarian, peace-cohesion, and resilience projects. A second activity will be to advocate for aspects of the youth program (Jigiya) to be added to the national ARISE PBF program.

Dr. Safouna DIAKITE, Chief Medical Officer of the Nioro Health District in Mali, came with funding from a Canadian NGO. He proposes to begin introducing some aspects of PBF in his health district, such as the indices health management tool and the PBF questionnaire from the health facility quality reviews. In addition, he proposes to advocate for his district to be enrolled in the national PBF program.

4           Mauritania

The group from Mauritania was the largest, with 18 participants, who impressed the participants from other countries with the progress of PBF. Indeed, PBF is in the scaling-up phase, reaching 80% of the population. The eight coordinators of the Regional Contracting and Verification Teams (ERV) came to Cotonou for their training, along with three members of the National PBF Unit (UN FBR), two inspectors from the Ministry of Health, and two representatives from the Ministry of Economy and Finance. There was a member of the PBF steering committee from the Ministry of the Interior who was also the village chief of Cotonou group 96. There was a participant from the Central Medicine Purchasing Agency (CAMEG) and an ophthalmologist from the national hospital.

The group noted that the PBF feasibility score was still low at 52%. The main problems identified are the lack of quality improvement bonuses (QIBs), a low state contribution, the monopoly on drug distribution, the failure to consider the geographic equity bonus in the calculation of stakeholders’ invoices, the overlapping of roles (ERV-Regional Council), and unnecessary procedures and bodies.

The Mauritanian group produced five action plans for the organizations they represent.

4.1       Ministry of Economy and Finance

We are very encouraged by the two representatives of the Ministry of Economy and Finance who proposed transforming specific existing but inefficient budget lines into PBF lines. They suggest introducing quality improvement bonuses that enable health facilities and regulatory authorities to make decentralized investments in rehabilitation, equipment, transportation, and the recruitment of qualified personnel, as well as to address the challenges faced by displaced persons along the border.

4.2       Results-Based Financing – National Unit (RBF-NU)

The RBF-NU group received the analysis from the ERV group, which worked on the PBF feasibility criteria in Mauritania. The recommendations in the RBF-NU action plan are as follows:

• Grant Quality Improvement Bonuses (QIBs) as quickly as possible.
• Introduce the geographic equity bonus.
• Merge the technical committee with that of the RBF-UN.
• Establish the payer under a pre-existing state institution.
• Revise the RBF-UN organizational chart to meet the needs of the INAYA Expanded Program.
• Increase the number of output indicators for the Complementary Package of Activities.
• Expand PBF to the private health sector.
• Authorize health facilities to purchase inputs (essential medicines) from authorized public and private distributors.
• Authorize health facilities to determine their cost recovery rates with their health committees.
• Empower facility managers, thus giving them greater autonomy to reassign excess civil servants to the Ministry of Health.
• Merge CRC and CR meetings into a single meeting.
• Budget and plan action research studies.

4.3       Ministry of Health Inspectors and CAMEG

The Ministry of Health inspectors proposed strengthening their capacity to play a regulatory role through inspections of public and private essential drugs and equipment wholesalers across the country. Health facilities can then purchase their inputs from authorized distributors instead of being forced to buy from a single government monopoly central purchasing agency. The group also suggests strengthening the national quality control laboratory (for medicines).

The CAMEG representative proposed strengthening the storage capacity of his organization’s regional branches and transportation.

4.4       PBF Steering Committee

The steering committee representative noted that the committee still lacks awareness of PBF “purity” feasibility criteria and PBF best practices. Furthermore, the government’s contribution to PBF subsidies is still low. He proposed discussing these issues within the committee, training other steering committee members (in a separate PBF course), and converting certain Ministry of Health budget lines into PBF subsidy lines.

4.5       Contract Development and Verification Agencies (ERV)

The eight regional Contract Development and Verification Agency (ERV) coordinators played a key role during the course and shared their field experiences with the other participants in a valuable way. They analyzed the feasibility criteria in detail and shared their work with the other Mauritanian groups.

The low PBF feasibility score of 52% surprised everyone, and this contributed to the quality of the recommendations in the action plans correcting the weaknesses. All five Mauritanian groups produced action plans with recommendations, which are summarized in the action plans above.

The ERV’s goal is to ensure the verification of providers’ output results, validate them, and submit them for payment. In addition to verification, the ERV is responsible for coaching and project implementation. The ERV works under the supervision of the Regional Council (RC). Yet, the PBF data validation process could be simplified.

5           Democratic Republic of Congo

The participant from the DRC, Alidor Kuamba, self-funded his presence in Cotonou after working for Cordaid and USAID. He made a good impression with an excellent comparative analysis between the PBF approaches in the Democratic Republic of Congo and Mali. There are several lessons, that he proposes to present at the Kinshasa National Technical Committee (CTN).

6           Benin

The participant from Benin, Emeline Tossou, also self-funded her PBF course and conducted an analysis of PBF in Benin, also based on a comparison with PBF in Mali. She proposes integrating PBF into the curriculum of the Regional Institute of Public Health and the National University of Benin.