I’ve been reading “An overview of research on the effects of results-based financing,” published by the Norwegian Knowledge Centre for Health Services, which discusses ten reviews of RBF schemes in low and middle-income countries (LMIC). What did they find?
- “Conditional cash transfer (CCT) programmes have been found to be effective at increasing the uptake of some preventive services which were already free.”
- “The success of CCT depends on the existence of effective primary health services and local infrastructures.”
- “Although financial incentives are considered to be an important element of strategies to change professional practice, there are relatively few well-designed studies and overall the evidence is weak.“
- “A small number of more rigorous evaluations have examined relatively simple preventive interventions, such as the impact on rates of immunizations and screenings, as opposed to more complex interventions. The success of a financial incentive is likely to be inversely related to the complexity of the tasks it seeks to motivate.”
Overall, it appears the quality of evaluation of RBF schemes has been relatively poor. The available evidence suggests we need to look more carefully at the (perhaps very specific) conditions under which RBF can work. I’m afraid RBF might not work well in the public sector in the absence of fairly strong government support and political commitment to the project. But that is something to be explored…