Performance-based Financing Experiment Improved Health Care in the Democratic Republic of Congo

In some low-income countries such as Cambodia and Rwanda, experimental performance-based payment systems have led to rapid improvements in access to health care and the quality of that care. Under this type of payment scheme, funders--including foreign governments and international aid programs--subsidize local health care providers for achieving certain benchmarks. The benchmarks can include such measures as child immunizations or childbirth in a health facility. In this article we report the results of a performance-based payment experiment conducted in the Democratic Republic of Congo, which is one of the poorest countries in the world and has an extremely high level of child and maternal mortality. We found that providing performance-based subsidies resulted in lower direct payments to health facilities for patients, who received comparable or better services and quality of care than those provided at a control group of facilities that were not financed in this way. The disparity occurred despite the fact that the districts receiving performance-based subsidies received external foreign assistance of approximately $2 per capita per year, compared to the $9-$12 in external assistance received by the control districts. The experiment also revealed that performance-based financing mechanisms can be effective even in a troubled nation such as the Democratic Republic of Congo.