Factors inhibiting and enabling performance-based financing in health care delivery across low and middle-income countries: a scoping review

ABSTRACT

Background: Emerging financing strategies in the health sector have been developed to improve the impact of investments and enhance healthcare outcomes. One promising approach is Results-based Financing, which establishes a connection between financial incentives and pre-established performance targets. This innovative approach holds the potential to strengthenhealthcare delivery and strengthen overall healthcare systems.Aim:The scoping review endeavored to systematically delineate the body of evidence pertaining tofacilitators and barriers to the implementation of performance-based financing within the realm of healthcare provision in low-and middle-income nations.Methods:The review used Preferred Reporting Items for Systematic Reviews and a Meta-Analysis extension for Scoping Reviews checklist to select, appraise, and report the findings. We searched PubMed, Web of Science, and Google Scholar databases and grey literature published between January 2000 and March 2022. We conducted the abstract screening with two independent reviewers. We also performed full-article screening. We used the six methodological frameworks proposed by Arksey and O'Malley. The results were thematically analyzed.Results:Of the 1071 searched studies, 34 met the eligibility criteria. 41% of the studies were descriptive, 26% cross-sectional, 18% trial, and 15% cohort studies. The enabling and inhibiting factors of performance-based financing in healthcaredelivery have been identified. Moreover, the review revealed that performance-based financing's influence on service delivery is context-specific.Conclusion:The facilitators and impediments to the effectiveness of performance-based financing in enhancing service delivery are contingent upon a holistic comprehension of the contextual factors, meticulous design, and efficient execution. Factors such as the level of care facilities, presence of community-based initiatives, stakeholder involvement, and participatory design emerge as key facilitators. Conversely, barriers such as communication obstacles, inadequacies in the PBF models, and deficiencies in the healthcare workforce are recognized as inhibitors. By harnessing the insights derived from a multitude of evidence incorporated in this scrutiny, stakeholders can deftly navigate the intricacies of performance-based financing, while also considering the prospective areas for further exploration and research