Table 1. Performance-Based Financing Models and Their Description .
| PBF Model | Description |
| Standard PBF (PBF1) | Performance contracts based on case-based payments method adjusted for quality were signed between the Ministry of Health and health facilities. Verification agencies were employed to verify service provision data submitted by individual facilities. PBF unit prices were calculated based on the relative cost and frequency of the services provided. Additional incentives were calculated on the basis of quantity outcomes and service quality if facilities achieved a quality score of 50% (and later changed to 60%), every quarter. Incentives were expected to pay for expenditures incurred, to increase savings and to pay bonuses to individual staff members. |
| PBF1 plus systematic targeting and subsidization of health services for the ultra-poor (PBF2) | Used the same health service purchasing model as PBF1, but had specific equity measures meant to ease access to and utilization of maternal healthcare services among the ultra-poor living in the catchment areas of the participating health facilities with the following components: (a) a systematic targeting of the ultra-poor to identify a maximum of poorest 20% of the population; (b) providing the identified ultra-poor with proof of status so they could access health services at no cost at the point of use; and (c) higher purchase unit prices than in PBF1 for health services delivered to the targeted ultra-poor (ie, as compensation for the lost revenues due to free health services provided to the ultra-poor at the point of use). The adjusted higher unit prices were only for services where user fees existed, such as tetanus toxoid vaccine, delivery and family planning services among others, while for services already provided free of charge at point of use, such as HIV and tuberculosis testing and treatment among others, the same unit prices as in standard PBF were used. The additional payments were removed in June 2016 after the introduction of the national free healthcare policy. |
| PBF2 combined with higher incentive purchase price to provide health services to the ultra-poor (PBF3) | Used the same purchasing arrangement as PBF1 and PBF2 and also involved the same targeting mechanisms and equity measures for the ultra-poor as in PBF2. The main difference was in the unit prices, whereby services provided to the ultra-poor were reimbursed at a higher unit price than in PBF2—at around 150% of the PBF2 unit prices. The higher unit prices were meant to compensate for the lost revenue from user fees, and also to offer health workers an additional incentive to motivate them to attract or reach out to the ultra-poor. This applied only to services where user fees were still charged at the point of use. These additional payment were removed in June 2016 after the introduction of the national free healthcare policy. |
| PBF1 plus community-based health insurance, combined with targeting and subsidization of health services for the ultra-poor (PBF4) | Involved implementation of PBF1 alongside CBHI whereby an annual insurance premium of 3900 F CFA (US$7) per individual was offered for the whole population using the same targeting mechanism as in PBF2 and PBF3. CBHI insurance premiums for the ultra-poor was fully paid for by the PBF program and payments to health facilities were made by both the CBHI scheme as a replacement for user fees and by the PBF program, using a case-based payment system as in PBF1. |
Abbreviations: PBF, performance-based financing; CBHI, Community-based health insurance.