Performance-based financing: just a donor fad or a catalyst towards comprehensive health-care reform?

performance-based financing is generating a heated debate. some suggest that it may be a donor fad with limited potential to improve service delivery. most of its critics view it solely as a provider payment mechanism. our experience is that performance-based financing can catalyse comprehensive reforms and help address structural problems of public health services, such as low responsiveness, inefficiency and inequity. the emergence of a performance-based financing movement in africa suggests that it may contribute to profoundly transforming the public sectors of low-income countries.