Start: 2010
Phase: pilot phase – scaling up in 2019
Estimate Coverage: 17%
Feasibility Score: 68%
Supported by: Ministry of Health; World Bank; KfW ; Belgium Cooperation, the common fund


Niger has implemented two PBF pilot projects: one in the Boboye health district in 2015 and; Another in the Tillabéri region in 2017. The favorable results justified the scaling up to 3.8 million inhabitants by the government with the financial support of about $ 15.2 million per year and technical support committed by the World Bank. The feasibility score, conducted by the three participants from Niger, based on 23 purity criteria, was 68%. In addition, they identified two killing assumptions that should be solved for PBF to be successful: 1. The negative effects of the single treasury account system that makes implementing PBF impossible and; 2. The existence of a monopoly for the purchase of medicines and other inputs.

Recommendations Niger

  • Make the national PBF unit operational and link it directly to the office of Secretary-General ;
  • Develop performance contracts with the central and regional Ministry of Health departments ;
  • Define the procedures for recruiting the Regional Contract Development and Verification Agencies. This can be through an international tender, or by identifying a local organization with an already existing legal status. The disadvantages of recruiting an organization after an international tender is that: 1. It lasts at least a year; 2. It is not a sustainable solution and ; 3. It is more expensive. To the contrary, identifying an already existing organization will not have these disadvantages but the contract should be made very SMART of what is being expected to prevent negative interference by local leaders.
  • Advocate with the Minister of Public Health for the allocation of the World Bank’s total health budget for performance-based funding approach instead of mixing it with other input components. Experience shows that a mixed approach does not work and creates confusion among the implementing agents.
  • Empower the organizations with PBF contracts by allowing them to open their accounts at commercial banks and to use the funds autonomously.
  • Develop performance contracts with all stakeholders (primary health facilities, hospitals, regulators) in the PBF regions.
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