Table 2.

Functions and tasks of institutional actors involved in performance-based financing implementation

Institutions	Functions	Tasks
✓ CSCOM	Service provision	- Propose and execute the results plan
✓ CSREF		- Negotiate and sign the contract
		- Produce the services and care
✓ For CSCOMs: Commune and ASACO (pays for the technical services)	Purchasing (contracting)	- Define priorities
		- Negotiate the results plan
✓ For CSREFs: Circle Council		- Negotiate and sign the contract
		- Launch the audit process
		- Purchase the outputs
✓ Project coordination unit/Strengthening Reproductive Health Project	Payment (for outputs produced)	- Pay, after purchaser has signed
		- Ensure availability of funds
✓ HDMT/RHD	Regulation	- Ensure norms and standards are respected – national policy
		- Coach health providers
✓ For CSCOMs: HDMT	Performance auditing of providers (quantity and quality)	- Audit the veracity and reliability of the numbers reported in health centre registers
✓ For CSREFs: RHD
		- Monitor technical quality
		- Submit a timely audit report to the purchaser
✓ Grassroots community organisation and independent external agency	Cross-auditing of performance at the user level	- Sign a contract with the purchaser
		- Verify whether each person actually received the services
		- Submit a timely audit report to the purchaser
✓ External auditor	Annual external auditing	- Verify the accuracy of the data and expenditures
✓ District management council	Steering committee	- Define programme policies and strategies
✓ National steering committee		- Ex-post monitoring
		- Arbitration in cases of differences of opinions between providers and payers or auditors
✓ Consultancy firm	Technical support

ASACO Association de santé communautaire (community health association), CSCOM Community health centre, CSREF reference health centre, HDMT Health district management team, RHD Regional Health Department