KIT Royal Tropical Institute has developed an approach for Results Based Financing (RBF) to enable partners in health to develop their own RBF model, adapted to their own context.
Improving Health Worker Performance
Result Based Financing aims to improve the performance of health care providers by using available resources more effectively. RBF turns the traditional prepaid funding model (advance funding of services based on a proposed budget) into a postpaid model based on verified results.
RBF is a ‘contracting approach’ between purchaser and provider, while a regulator ensures that results are produced within national norms and standards. In addition, an independent organisation verifies the reported results. Assessments suggest that RBF can improve health service delivery better than traditional input financing mechanisms since they are more successful in motivating health workers.
Result Based Financing and Universal Health Coverage
At KIT we consider RBF and Universal Health Coverage (UHC) to be a natural fit, because RBF has the potential to improve efficiency of the health system and increase productivity of health workers, while ensuring quality, equitable services at an affordable cost – so that more people have access to higher quality services. In this way RBF may be a powerful instrument for UHC mechanisms.
The first experiences in RBF in Africa come from Rwanda. Since then, RBF has been brought to different African countries. KIT has developed an approach to RBF which is distinct from a ‘model’ for it – however it is based on the same principles. The four steps of our approach are as follows:
- Develop with local partners through action-research a model for RBF, specific to the given context. KIT’s focus is on developing the institutional framework for RBF within the existing governance structure.
- Create opportunities to strengthen demand-side initiatives. Through including the patient’s voice in the governance of health care, providers are stimulated to make their services more responsive to the health wants and needs of the population.
- Focus on quality of care, rather than on increasing quantity of services.
- Focus on impact evaluation. Create a mix of quantitative and qualitative methods not only to assess if it worked, but also to determine if it worked, what works why for whom?
The KIT approach to RBF was developed in Mali for, and in close coordination with, the Ministry of Health who were interested to develop a “RBF à la Malienne”.
Applying RBF in Your Context
Attempting to ‘copy and paste’ the Mali model is not recommended; RBF principles should be adapted to your context through a process approach.
The Mali approach – not the model – has been used successfully – supported by KIT – in Ghana. In that case, the application of the approach resulted in a different model. The same result occurred in Benin.