In this seminar Igna Bonfrer will present research findings from recent work which evaluates the Performance based financing (PBF) in Burundi and wether this has led to changes in the quantity and quality of health care services provided.

Performance based financing (PBF) has attracted considerable interest from governments and aid agencies in low income countries as a means to increase productivity and quality of health care providers. In Africa alone, more than 35 countries are in the process of introducing payment methods that reward performance. The Burundi government has gradually rolled out PBF across all provinces between 2006 and 2010.

In this research the staggered rollout of PBF was exploited to do a difference-in-differences analysis using data from 2006 (baseline), 2008 and 2010. Repeated cross-sectional data were collected among a random sample of 3200 households and panel data for 75 randomly selected health care facilities across intervention and control provinces. The findings were that PBF increased the probability of women delivering in an institution by 17 percentage points, the probability of using antenatal care by 6 percentage points, and the use of modern family planning services by 7 percentage points. The overall facility quality score as constructed by external audits increased with 46 percent but no effect of PBF was found on the quality of care as reported by patients. Findings also indicated no effects of PBF on vaccination rates and the satisfaction with waiting times decreased. There is no strong evidence for unequal effects of PBF across socioeconomic groups.

The research findings suggest that the introduction of performance based financing (PBF) in Burundi has led to significant increases in mother and child care utilization and in the quality scores of health care facilities. Given the rising popularity of this financing strategy, more robust evidence on its effects is warranted.

Igna Bonfrer is a PhD student at the Institute of Health Policy and Management (Erasmus University), supervised by Prof. Dr. Eddy van Doorslaer and Prof. Dr. Michael Grimm (ISS, The Hague). Her research is on the financial protection of households against catastrophic health expenses in Sub-Saharan Africa.