The Performance-Based Funding (PBF) Debate

Abstract

This chapter outlines the main debate over results and performance-based funding (PBF) and the application of PBF to health system reform in Africa. It introduces the reader to principal-agent theory as the central approach to PBF adopted by the World Bank and Global Fund and outlines the many concerns and contentions associated with PBF. In so doing the chapter begins to show how global health institutions have adopted a positive bias to PBF as a tool for health system reform and that we know little about the role of African actors in the shaping and implementing of PBF programmes and in generating the evidence base that underpins them.