Performance-based Financing in Africa: Time to Test Measures for Equity

Author:

Ridde Valéry12ORCID,Gautier Lara23,Turcotte-Tremblay Anne-Marie2,Sieleunou Isidore2,Paul Elisabeth4

Affiliation:

1. CEPED, IRD, Université Paris Descartes, Inserm, équipe SAGESUD, Paris, France

2. University of Montreal Public Health Research Institute (IRSPUM), Montreal, Canada

3. Centre d’Etudes en Sciences Sociales sur les Mondes Africains, Américains et Asiatiques (CESSMA), French Institute for Research on Sustainable Development (IRD), Université Sorbonne Paris Cité

4. Université de Liège, Faculty of Social Sciences, Liège, Belgium

Abstract

Over the past 15 years, hundreds of millions of dollars have been invested in reforms founded on performance-based financing (PBF) in low- and middle-income countries. While evidence on its effectiveness and efficiency is still controversial, there appears to be an emerging consensus that equity has not been adequately considered. In this article, we show how PBF-type interventions in Africa have not sufficiently taken into account equity of access to care for the worst-off and their financial protection. In reviewing the history of health reforms in Africa, we show that this omission is nothing new. We suggest that strategic purchasing and PBF-type actions would benefit from being implemented in ways that promote equity and the financial protection of populations in Africa. Without such a reorientation of reforms, it will be impossible to achieve universal health coverage by 2030.

Funder

Institute of Population and Public Health

Publisher

SAGE Publications

Subject

Health Policy

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