The upcoming 99th PBF course will take place in Cotonou from November 16 to 28, 2026.
Please find the announcement (annonce) and registration form (fiche) attached.
The 97th international course, held in Cotonou from June 30 to July 12, was a success and drew 32 participants from six countries. The largest group came from Mauritania (14), followed by Mali (7), the DRC (1), the CAR (1), Chad (1), and Niger (1).
This course differed from previous ones in that the facilitation team provided feedback on group action plans very early on—right from the start. This allowed groups to revise and improve their action plans up to four or five times.
Hereby, the course report (rapport)
1. Some impressions of the course
Fifty-seven percent of participants felt the two-week course was too short, as was the time allocated for discussions and group work. Participants found the modules on microeconomics, health economics, and theory difficult.
The average score on the final test was 73.3%, slightly lower than the averages from previous Francophone courses. There were seven distinctions (90% or higher), 25 merits (53% to 87%), and two participation-only results (50% or lower). Women were significantly underrepresented in the course, with only four participants; however, their average final-test score was 79%—six points higher than men’s.
2. Evidence that PBF yields good results
In 2024 and 2025, three World Bank project completion reports showed that PBF (Performance-Based Financing) has achieved excellent results—in both quantity and quality—in Burundi, Zimbabwe, and Mali over the past 20 years. Furthermore, support outcomes for vulnerable populations in Mali improved significantly through full implementation of PBF equity mechanisms, and health facilities were paid on time. This latter point is crucial, as health facilities must initially pre-finance the free care provided to vulnerable groups.
In 2026, another PBF intervention-versus-control study in Chad—covering nine million beneficiaries—yielded significant results for 19 out of 27 output indicators and showed quality improvements ranging from 14% to 36%. This success was achieved despite a relatively low feasibility score of around 60%, showing that outcomes could be even more significant if Chad’s PBF program were better designed.
In conclusion, substantial and growing evidence shows positive PBF outcomes across various countries and contexts.
3. Why, then, do countries not embrace PBF reforms more fully?
The primary reason appears to be that central authorities prefer to retain control over managing inputs rather than making direct payments based on results to providers, district management teams, community associations, and other stakeholders within the PBF system.
A secondary reason is that some academic articles have questioned the merits of PBF. However, we believe this criticism was unfounded, as those academic studies were based on flawed PBF conceptual designs.
To address this, SINA Health has spent approximately twelve years developing a feasibility scoring tool comprising 23 criteria. A lower score reduces the likelihood of success; achieving a score of at least 80% is recommended to ensure a successful outcome. 4. Mauritania
4. Mauritania
The Mauritania group was the largest, with 15 participants. The PBF scheme is currently being scaled up to cover 80% of the population and will also include part of the capital city, Nouakchott.
Participants from Mauritania noted that the RBF feasibility score was still low, at 44%. Key issues identified included the absence of quality improvement bonuses (QIB), a low state contribution (10%), a monopoly on medicine distribution, the failure to factor the geographical equity bonus into provider payment calculations, overlapping roles (between the Regional Verification Entity and the Regional Council) and procedures, and the existence of redundant bodies. The group developed a robust advocacy plan to improve the conceptual design of the PBF scheme in Mauritania and proposes scaling it up to 100% nationwide.
5. Mali
Thirteen participants from Mali attended the training, and one self-funded their participation. The Malian group comprised three members of the PBF national steering committee, along with representatives from eight regions and two districts. Five Malian participants achieved distinction in the final exam. They played a significant role during the training and contributed to highly engaging discussions.
Their action plans focused on ensuring the sustainability of PBF in Mali, planning action research on urban PBF, and addressing mechanisms and instruments for emergency PBF.
The urban PBF initiative about to launch in Bamako’s District VI requires an approach tailored differently from the traditional model. PBF has successfully piloted the urban approach in Douala and Yaoundé; this model relies primarily on public-private partnerships and ensures non-discrimination in allocating PBF contracts.
5. Chad
A staff member from the World Bank office in N’Djamena attended the course and played a key role in explaining PBF to the other participants. His action plan focuses primarily on PBF’s long-term sustainability in Chad. He shared an evaluation report on the PBF-control group intervention, which strongly supported the PBF approach.
6. Central African Republic
The representative from the CAR, who attended on a self-funded basis, is responsible for vaccination programs in the country. He developed an action plan to make better use of PBF tools to improve vaccination rates and to conduct action research on this subject.
7. Niger
The representative from Niger works for an NGO that acts as the Verification Agency (ACV) in the country. He identified several conceptual and organizational issues within the PBF program in Niger. He developed an advocacy action plan to accelerate PBF rollout in Niger. We are observing growing interest in Niamey—particularly from a new team within the national PBF technical unit—in advancing the PBF agenda.
8. Democratic Republic of the Congo
The DRC representative works as a World Bank consultant.
He developed an action plan on how the DRC government could better integrate emergency PBF instruments into the national PBF program, which covers much of the country.
