The ambition of the SDGs in the field of health is a major challenge for developing countries and their external partners. This is not just a matter of stepping up the resources available for health, but also of introducing or developing the use of managerial and organisational approaches as an integral part of reforms likely to further the achievement of the SDGs targeting the health sector. So-called “results-based financing” (RBF), “performance-based financing” (PBF), or P4P (we use the generic term RBF) occupy a particularly important place in the debates on these issues.
While interest in the RBF approach is undoubtedly now shored up by the SDGs’ ambition in the field of health, it had in fact already gained ground with the drive towards the Millennium Development Goals, when it became clear that insufficient headway would be made in the field of health were the “business-as-usual” approach to be maintained, with only an increase in available resources. Various studies had sounded the alarm regarding both the poor quality of care frequently observed—which did not forcibly stem from a lack of resources—and the fact that the systemic dynamics did not encourage better use of the scarce available resources. As a result, health indicators were lastingly doomed to fall short of what they could have been. The RBF approach provides a response—but only one among many—that is being implemented with a growing interest in view of meeting these enduring challenges and helping speed up the advance towards “healthy lives…for all at all ages”, as stated in Goal 3 of the SDGs.
We have captured the main effects of the RBF approach in developing countries, as seen in the literature, so as to draw lessons that are directly useful for the effectiveness and efficiency of health policies.