Start: 2003
Phase: WB performance-based contracting programme 2003-2005, New Cordaid financed pilot since 2009, other pilots such as from DFID and demand side voucher programs
Coverage Estimate: 60%
Feasibility: 42%
Supported by: Government, WB, USAID, DFID, SIDA, Cordaid

Budget : WB $ 68 million 2016-2020

Description: The World Bank-financed RBF project 2003-2006 (Performance-Based Contracting) had many imperfections and consequently failed to deliver desired results. New pilots have been started by faith-based organizations financed through Cordaid and USAID. 

A new framework has been developed in 2018 for the implementation of RBF in two third of the country. Yet the team in Mombasa scored the feasibility of the current design with 42% and they identified several points for improvement:

  • The per capita budget for PBF is only USD 2.50, while at least USD 4.00 is considered necessary for a well-designed holistic PBF programme;
  • The number of indicators is only 10 with a vertical orientation towards reproductive health care, while a minimum of 25 is recommended.
  • The current package does not contain community PBF indicators;
  • Government health facility managers are not allowed to spend their locally generated revenues from cost-sharing at the point of collection;
  • Health facilities do not have a right to decide where to buy their inputs. They depend on the central distribution for inputs such as essential drugs and equipment;
  • The verification agency is the DHMT, which is also the regulatory authority at the local government level. This violates the RBF principle of separating functions. Thus, there is a need to create an independent CDV agency.
  • There are no geographic and/or facility-specific equity bonuses
  • There are no equity bonuses for vulnerable people. Instead, there is generalized free health care that is inefficient and produces a poor quality of care.
  • The National RBF program data management system is still manual and not linked to the DHIS 2
  • There are no output indicators at the national and regional RBF Units 


Given the discrepancies between the PBF best practices and the currently proposed RBF National Framework design, the Uganda team proposes:

  • To review the current RBF design and notably: (1) review the budget and the scope of indicators; (2) review and change the CDV function from the regulatory DHT function
  • Adoption of the free market system for facility commodities
  • Digitalize RBF data management system.

Ssengooba, F., B. McPake, et al. (2012). “Why performance-based contracting failed in Uganda – An “open-box” evaluation of a complex health system intervention.” Social Science & Medicine (in press).

Orem, J. N., F. Mugisha, et al. (2011). “Abolition of user fees: the Uganda paradox.” Health Policy and Planning 26(Supplement 2): 41-51.

Morgan, L. (2010) “Some Days are Better than Others: Lessons Learned from Uganda’s first Results-Based Financing Pilot”.

Bellows, B. and M. Hamilton (2009). “Vouchers for Health: Increasing Utilization of Facility-Based STI and Safe Motherhood Services in Uganda. Maternal and Child Health P4P Case Study”. Bethesda MD, Health Systems 20/20 Abt Assoc Inc.

Print Friendly, PDF & Email