Health financing

Performance-based financing

An Afghan doctor discusses with a woman postnatal care and benefits of exclusive breastfeeding.
N. Ansari

Performance-based financing (PBF) or pay-for-performance (P4P) is a form of incentive where health providers are, at least partially, funded on the basis of their performance to meet targets or undertake specific actions. It is defined as fee-for-service-conditional-on-quality.

In many low- and middle-income countries P4P programmes are implemented with the support of development partners and are referred to as Results-Based Financing (RBF). RBF is an umbrella term for an instrument that links rewards with performance. P4P/PBF/RBF should be viewed as a step in the process of moving systems towards more strategic purchasing.

Performance-based financing in more detail

Performance-based financing as an instrument to introduce strategic purchasing to move towards universal health coverage

Performance-based financing is a form of service provider payment defined by three main distinguishing features.

Main lessons on performance-based financing programmes to date

Four key lessons from experiences to date of implementing PBF provide valuable insights.

Questions to ask before implementing performance-based financing

Performance-based financing should be viewed as part of other reforms aimed at strengthening health systems to achieve universal health coverage.


Sharing and debating country experiences on health financing: Fiscal sustainability and transition, public finance management, and results-based financing

Meeting 14 December 2016

Forum for sharing and debating country experiences on issues that are of great relevance to health financing reforms, and that are high on the agenda of both countries and international agencies.