Publication: Verification of Performance in Result-Based Financing : The Case of Burundi
Loading...
Published
2013-07
ISSN
Date
2014-04-16
Author(s)
Editor(s)
Abstract
Paying health facilities incentives based on their performance is one form of results-based financing (RBF). Verification of the performance of the providers is a vital part of RBF program implementation. Burundi was one of the first African countries to introduce performance-based financing (PBF). The PBF scheme is implemented in the whole country and is led by the Ministry of Health (MoH). It pays incentives based on quantity of services provided as well as a quality of care component. This study describes the methods used for verification in Burundi, which include monthly verification of the quantity and technical quality of services provided on a quarterly basis; semiannual patient tracing and assessment of patient satisfaction; and counter-verification of the information provided by these three mechanisms. The results of verification are presented and it discusses obstacles to verification, how they have been addressed, and the challenges ahead. The case study is part of a broader analysis, which includes multiple country case examples, to expand knowledge about the verification process and practices to address the design and implementation needs of RBF programs.
Link to Data Set
Citation
“Renaud, Adrien. 2013. Verification of Performance in Result-Based Financing : The Case of Burundi. Health, Nutrition, and Population (HNP)
discussion paper;. © http://hdl.handle.net/10986/17855 License: CC BY 3.0 IGO.”
Digital Object Identifier
Associated URLs
Associated content
Other publications in this report series
Journal
Journal Volume
Journal Issue
Related items
Showing items related by metadata.
Publication Verification of Performance in Results-Based Financing : The Case of Community and Demand-Side RBF in Rwanda(World Bank, Washington, DC, 2014-06)Rwanda, led by its Ministry of Health, was the first African country to implement Performance- Based Financing (PBF) nationwide in its health centers and hospitals. The country then went on to pilot RBF interventions at the community level. Rewarding community members who provide and use Maternal and Child Health (MCH) services is an innovative form of Results-Based Financing (RBF). The supply-side of this community PBF scheme focuses on cooperatives of Community Health Workers (CHWs). It pays them to provide selected MCH services and rewards them for the quality of their reporting as well as for good management. Conversely, the demand-side of this community PBF scheme provides women with in-kind incentives when they utilize three selected MCH services in health centers. Verifying the performance of these interventions is an integral part of RBF program implementation. This case study aims to describe the verification mechanisms used in Rwanda, which include monthly verification of the quantity of services provided by the CHWs, quarterly assessment of the quality of the functioning of the CHW cooperatives (including its reporting), verification of the quantity of in-kind incentives distributed in a less systematic way, as well as counter-verification of these three verification processes. This paper presents results of these verification methods, and discusses the obstacles faced, the way they were addressed, and the challenges that are still ahead. This case study is part of a broader analysis, involving multiple country case examples. It endeavors to expand knowledge about verification processes and practices and to address the design and implementation needs of RBF programs.Publication Verification of Performance in Results-Based Financing(World Bank, Washington, DC, 2015-08)The Ministry of Public Health in Afghanistan implements a supply-side results-based financing (RBF) scheme to improve the provision of a standardized basic package of health services (BPHS) to its population. Contracting NGOs and “contracting-in” MOPH providers, this RBF program concentrates on high-priority maternal and child health services in the BPHS such as antenatal care (ANC), post-natal care (PNC), delivery care, nutrition, immunization coverage, tuberculosis (TB), as well as quality of care. It includes an intensive data verification method, focusing on both the quantity and the quality of delivered services, which was implemented between 2010 and 2013 by international third party organizations. This verification method was specifically used to ensure that providers reach performance thresholds and disburse performance payments. This case study describes the major characteristics of this RBF verification method. Taking stock of the experience of the MOPH, it aims at generating possible lessons for other RBF initiatives, thereby expanding knowledge and making RBF verification processes more efficient, sustainable and effective. This case study also responds to concerns about the future sustainability of RBF, particularly with regard to the intensive and external nature of verificationPublication Kyrgyz Republic Public Expenditure Review Policy Notes : Health(Washington, DC, 2014-05)Over the past two decades the Kyrgyz Republic implemented important health financing and organization reforms. Compared to other former Soviet republics and other low-income countries, the Kyrgyz Republic shows good results in term of health outcomes, access to health services, and financial protection. Life expectancy exceeds that of several of the most prosperous former Soviet republics, including Russia. Infant and under-5 mortality rates were halved between 1990 and 2010. More than 98 percent of births are attended by skilled health staff and children immunization rates exceed 90 percent. Utilization of both hospital and outpatient health services are quite equal across income groups. Overall distribution of public health spending is slightly pro-poor. The Kyrgyz health system shows low incidence of catastrophic and impoverishing out-of pocket spending for health care.Publication The Health Extension Program in Ethiopia(World Bank, Washington, DC, 2013-01)Ethiopia has made substantial progress in improving health outcomes during the last decade and is on track to achieve some of the health Millennium Development Goals. Innovative strategies to improve household behaviors and coverage of basic health care services contributed to Ethiopia's achievements, and the Health Extension Program (HEP) remains the core of such innovations and provides a model for countries struggling to improve health outcomes in a resource-constrained setting. The program rests on an accelerated expansion of basic health infrastructure and local human resources with required skills to scale-up delivery of high-impact interventions focusing on improving the supply of and enhancing demand for a well-defined package of essential promotive, preventive, and curative health services. The objectives of the case study are to provide a detailed description of (a) the context for the introduction of the program; (b) the scope of the service package delivered under the program; and (c) the institutional arrangements and the links with the rest of the health system. The case study also summarizes and discusses the evidence of the program's achievements and the challenges to achieving universal primary health care coverage. The study also discusses the importance of political will and commitment in introducing such large-scale innovations in improving service delivery and mobilizing the community in a resource-constrained setting.Publication Ethiopia : Improving Health Service Delivery(World Bank, Washington, DC, 2009-08)This case study aims to identify how Ethiopia has adopted and implemented strategies to improve health services, including the factors that enabled and inhibited success across a meaningful range of health services for the period 1996-2006. Particular emphasis has been given to the impact of utilized strategies on the poor. This case study reviewed one 'primary strategy', decentralization in the form of devolution of authority to the regional level in 1996 and to the district (woreda) level in 2002, and seven 'corollary strategies' in the context of decentralization implemented at the subnational level. The study concludes that decentralization in the health sector is likely to be more effective when it is implemented as part of a broader government decentralization policy across sectors. Sequencing in implementing Ethiopia's decentralization strategy made decentralization more manageable, although decentralization was rolled out prematurely. Moreover, the effectiveness of implementation was found to be driven largely by the institutional and management capacity at the subnational level. At the subnational level, decentralization was found to be more effective in those regions that increasingly strengthened their management and institutional capacity and where regional governments set priorities and adapted the strategies to local needs. However, decentralization was often influenced by the 'clientelistic' center, region power relationship, a problem compounded by the lack of community voice, making the available resources at risk of political capture by the local elite. Overall, the key lesson for implementing improvements in health service delivery (HSD) is that the lack of any critical inputs (facilities, health workers, and drugs) inevitably limits the overall impact of the strategy, and that the implementation of such key inputs should be carefully coordinated and properly synchronized.
Users also downloaded
Showing related downloaded files
Publication Digital Africa(Washington, DC: World Bank, 2023-03-13)All African countries need better and more jobs for their growing populations. "Digital Africa: Technological Transformation for Jobs" shows that broader use of productivity-enhancing, digital technologies by enterprises and households is imperative to generate such jobs, including for lower-skilled people. At the same time, it can support not only countries’ short-term objective of postpandemic economic recovery but also their vision of economic transformation with more inclusive growth. These outcomes are not automatic, however. Mobile internet availability has increased throughout the continent in recent years, but Africa’s uptake gap is the highest in the world. Areas with at least 3G mobile internet service now cover 84 percent of Africa’s population, but only 22 percent uses such services. And the average African business lags in the use of smartphones and computers as well as more sophisticated digital technologies that catalyze further productivity gains. Two issues explain the usage gap: affordability of these new technologies and willingness to use them. For the 40 percent of Africans below the extreme poverty line, mobile data plans alone would cost one-third of their incomes—in addition to the price of access devices, apps, and electricity. Data plans for small- and medium-size businesses are also more expensive than in other regions. Moreover, shortcomings in the quality of internet services—and in the supply of attractive, skills-appropriate apps that promote entrepreneurship and raise earnings—dampen people’s willingness to use them. For those countries already using these technologies, the development payoffs are significant. New empirical studies for this report add to the rapidly growing evidence that mobile internet availability directly raises enterprise productivity, increases jobs, and reduces poverty throughout Africa. To realize these and other benefits more widely, Africa’s countries must implement complementary and mutually reinforcing policies to strengthen both consumers’ ability to pay and willingness to use digital technologies. These interventions must prioritize productive use to generate large numbers of inclusive jobs in a region poised to benefit from a massive, youthful workforce—one projected to become the world’s largest by the end of this century.Publication Accelerating Investment: Challenges and Policies(Washington, DC: World Bank, 2025-09-19)Investment is the engine that expands productive capacity, modernizes infrastructure, creates jobs, and drives progress toward development and climate goals. Yet developing economies face an investment shortfall of historic proportions. Even as development needs rise, investment growth has slowed to about half its pace in the 2000s. Public investment alone cannot fill this gap. Private investment must play the leading role in reigniting growth, creating jobs, and supporting the transition to a more sustainable and resilient future. This book presents the World Bank’s most comprehensive assessment of investment in emerging and developing economies. It examines why investment matters, why it has stalled, and what it will take to revive it. The analysis highlights that countries that have successfully triggered investment booms combined sound macroeconomic frameworks with reforms that improved the business climate, strengthened governance, and mobilized private capital. History shows that when investment surges, economies grow faster, job creation accelerates, and poverty declines more rapidly. Reversing today’s slowdown is within reach — through credible fiscal and monetary policies, well-targeted public investment that attracts private capital, and stronger international cooperation to mobilize finance at scale. Reigniting investment is not just a national priority — it is a global imperative.Publication Commodity Markets Outlook, October 2025(Washington, DC: World Bank, 2025-10-29)Commodity prices are expected to decline by about 7 percent overall this year, reflecting subdued global economic activity, elevated trade tensions and policy uncertainty, ample global supply of oil, and weather-related supply shocks. In 2026, commodity prices are forecast to fall by a further 7 percent, a fourth consecutive year of decline, as global growth remains sluggish and the oil market oversupplied. Energy price movements are envisaged to continue contributing to global disinflation in 2026. Metals and minerals prices are expected to remain stable in 2026, while agricultural prices are projected to edge down, primarily due to strong supply conditions. Precious metals prices are expected to rise another 5 percent, after a historically large, investment-driven rally of about 40 percent in 2025. Risks to the commodity price projections are tilted to the downside. Key downside risks include weaker-than-expected global growth, a longer-than-assumed period of economic policy uncertainty, and additional oversupply of oil. Upside risks include intensifying geopolitical tensions, the market impact of additional oil sanctions, supply reductions stemming from additional trade restrictions, unfavorable weather conditions, faster-than-expected rollout of new data centers. Commodity price volatility in recent years has revived interest in supply management via international commodity agreements. Historical experience, however, shows that the most effective policy is to promote diversification, innovation, transparency, and market-based pricing—measures that build lasting resilience to commodity price volatility.Publication Why Do Emerging Economies Borrow Short Term?(World Bank, Washington, D.C., 2004-09)The authors argue that emerging economies borrow short term due to the high risk premium charged by international capital markets on long-term debt. They first present a model where the debt maturity structure is the outcome of a risk-sharing problem between the government and bondholders. By issuing long-term debt, the government lowers the probability of a liquidity crisis, transferring risk to bondholders. In equilibrium, this risk is reflected in a higher risk premium and borrowing cost. Therefore, the government faces a tradeoff between safer long-term borrowing and cheaper short-term debt. Second, the authors construct a new database of sovereign bond prices and issuance. They show that emerging economies pay a positive term premium (a higher risk premium on long-term bonds than on short-term bonds). During crises, the term premium increases, with issuance shifting toward shorter maturities. This suggests that changes in bondholders' risk aversion are important to understand emerging market crises.Publication Budget Execution in Health(World Health Organization and the World Bank, 2025-03-11)This report builds on a joint WHO-World Bank initiative on budget execution challenges (described in more detail in Appendix 1). Following the introduction, section 2 provides an overview of core concepts from both a public financial management perspective and a health financing perspective and discusses how budget execution challenges can differ in countries with a separate purchasing agency, varying degrees of decentralization and significant donor funding. The trends and patterns in health budget execution data are analyzed and discussed in section 3. The analytical approach is detailed in Appendix 2. Section 4 identifies challenges that hinder good budget execution in health. These are drawn from an extensive literature review and a set of case studies. A summary of the case studies is provided in Appendix 3. Policy responses to these challenges are offered in section 5. This section lays out a pragmatic approach that Ministries of Finance, Ministries of Health and local governments can take to address six of the most frequently encountered budget execution challenges and points to examples from cases studies. Section 6 offers an engagement approach to address budget execution challenges. A four step diagnostic-to-solution model is proposed that guides an analyst through the process of identifying the right questions, data, and policy options in a structured manner. Section 7 concludes with a call to action for countries to embrace a more purposeful and collaborative budget implementation approach that involves finance, health and local government stakeholders. The compiled dataset used for the analysis is being released jointly with this report to support complementary analytical efforts.