Start: 2003 and 2012
Phase: RBF initiatives nationwide
Coverage Estimate: RBF 100%, PBF applied in Uruzgan Province
Feasibility: Reasonable
Supported by: MOH; WB; Cordaid

Description: RBF or general contracting through NGOs was introduced since 2002. However, this is a Performance-Based Contracting approach with centralization, limited autonomy of health facilities and no contracts with private health providers. NGOs tend to mix the roles of CDV Agency, financing and provision. A successful “pure” PBF pilot was conducted by Cordaid in Uruzgan province in August 2012, with encouraging results but was not scaled up.

The RBF-light initiatives have now expanded nationwide, whereby the implementors claim that contracting out with NGOs has the best results compared to contracting-in. The World Bank financed SEHAT project includes a supply-side performance-based financing scheme. Under this scheme, the MPOH contracts-in MPOH providers and contracts-out international/national Non-Governmental Organizations (NGOs) to improve the coverage and quality of the BPHS and EPHS. Inherent RBF payments are disbursed every semester based on the quantity and the quality of services delivered.

Amelli, O. and W. Newbrander (2008). “Contracting for health services: effects of utilization and quality on the costs of the Basic Package of Health Services in Afghanistan.” Bulletin of the World Health Organization.

Arur, A., D. Peters, et al. (2009). “Contracting for health and curative care use in Afghanistan between 2004 and 2005.” Health Policy and Planning.

Loevinsohn, B. and G. D. Sayed (2008). “Lessons From the Health Sector in Afghanistan: How Progress Can Be Made in Challenging Circumstances.” JAMA 300(6): 724-726.

Loevinsohn, B. (2008). Performance-Based Contracting for Health Services in Developing Countries: a toolkit. Washington DC.

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