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World Bank Supports Performance-Based Financing Pilot in Primary Health Care


The National Forum, entitled “Implementation of New Primary Health Care Financing Mechanisms”.
World Bank
The National Forum, entitled “Implementation of New Primary Health Care Financing Mechanisms”. World Bank

Innovative financing approaches for primary health care (PHC) to improve service delivery were the topic of discussion today at a forum in Dushanbe that was co-hosted by the Ministry of Health and Social Protection of Tajikistan and the World Bank. The Minister of Health and Social Protection of Tajikistan, Salimzoda Nusratullo Faizullo, and the World Bank Country Manager, Patricia Veevers-Carter, opened the workshop, which was attended by relevant central and regional government agencies, PHC providers, development partners, as well as health sector officials from China and Armenia.

The National Forum, entitled “Implementation of New Primary Health Care Financing Mechanisms”, discussed international experiences in using various methods of financing in primary health care, including early lessons learned from the piloting of a new Performance-Based Financing (PBF) model in Tajikistan.

The PBF approach is being piloted in the Spitamen district of Tajikistan since April 2014 under the World Bank-financedTajikistan Health Services Improvement Project, which seeks to increase the coverage and quality of basic primary health care services through PBF.

“I am pleased to participate in this forum today to discuss how performance-based financing in the primary health care sector can improve the delivery of health services in rural areas of Tajikistan, resulting in better health outcomes for children and adults alike,” said Patricia Veevers-Carter, World Bank Country Manager for Tajikistan.

As opposed to the traditional method of paying for inputs, such as training and equipment, PBF instead pays for results achieved, such as the number of fully vaccinated children, the number of malnourished children properly counseled on nutrition, the number of pregnant women receiving antenatal care and women who have given birth receiving postnatal care, and the number of hypertensive patients detected and registered. This financing approach helps countries get more from their own and donors’ funds.  Early research shows that countries that use PBF can get 20 percent more health care for the same amount of money, and at a higher quality of care.  

Under the project, primary health care facilities are rewarded with additional payments based on their performance in meeting certain pre-agreed maternal, child, and other health targets. Performance will be subject to a rigorous verification process prior to payment.

According to the discussions at the workshop, the pilot in Spitamen district shows a positive change in facility performance. However, the early experience highlights the importance of continuous monitoring and technical support to the PHC facilities during the final phase of the pilot and prior to scaling-up of the scheme.   

Starting in early 2015, implementation will be scaled up to seven additional districts, covering a total of 1.86 million people in eight districts of Khatlon and Sughd, and representing around 25 percent of the population.

The Tajikistan Health Services Improvement Project is a US$19.8 million grant that aims to improve maternal and child health outcomes by providing incentive payments for better performance in coverage and quality of basic primary health care services in rural health facilities of Tajikistan. The project is being financed through a US$15 million grant from the International Development Association (IDA) and a US$4.8 million grant from the multi-donor Health Results Innovation Trust Fund (HRITF). Since 2000, the World Bank has been supporting Tajikistan in strengthening the country’s health sector through the introduction and implementation of health reforms, including per capita financing for primary healthcare, strengthening capacity of medical workers, and rehabilitation of infrastructure.  

The portfolio comprises 13 investment operations with net commitments of US$220.6 million. The largest share of the portfolio is in urban, rural and social development (21%), followed by agriculture (18%), energy (16%),  governance (10%), environment and natural resources (7%), health, nutrition & population (7%), education (7%), water (7%), trade and competitiveness (5%), social protection and labor (2%).

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