The effects of Performance-Based Financing on the uptake of health services in low-and-middle-income countries: A systematic review

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Background Many low- and middle-income countries (LMICs) have adopted Performance-Based Financing (PBF) since the late nineties to improve health system effectiveness and efficiency. Two previous systematic literature reviews assessed the effect of PBF on the uptake of specific health services such as HIV/AIDs and modern family planning. Another two assessed its effect on different aspects of the health system including health outcomes. This systematic review specifically assessed the effects of PBF implemented in LMICs on uptake of health services. Method Relevant scientific databases include PubMed, Academic Search Premier, Africa Wide Information, APA Psych Info, Business Source Premier, CINAHL, COCHRANE, EconLit, SCOPUS, Humanities International Complete, African Index Medicus, IndMed, Business Source Premier and Web of Science for: - randomised control trials, contemporaneous comparative studies, time-series studies, and impact evaluation papers published between 2000 and 2019 that evaluated PBF and its effect on the uptake or use of health services. A narrative synthesis was used due to wide variations in the methodologies of the included papers. Result Fifteen papers were eligible for analysis, and they are from Asia (3) and sub-Saharan Africa (8), the rests are literature reviews (4). PBF had mixed effects on uptake of targeted health care services in general but specifically showed great promise in the uptake of institutional delivery. It also improved the quality of care and had a mixed effect on equity. Limitations The research produced contemporary evidence on the effect of PBF on the utilization of health care services in LMICs. Furthermore, besides public health institutions especially primary health care centres, it also assessed the effect of PBF on faith-based clinics, and among informal health care providers thereby giving a holistic view of the effect of PBF, reflecting the contexts of LMICs. A major limitation is that the sample size is small to make a generalized conclusion on the effect of PBF on the uptake of health care services in LMICs. Another limitation is that only peer r eviewed paper s wer e analysed and they have diverse methodological approaches and varied contexts, hence unsuitable to conduct a meta-analysis. Again, the research was conducted using papers published in English alone, which limits the resources available to analyse the outcome effect. Conclusion PBF had a mixed effect on the uptake of targeted health care services in LMICs, more research is needed for robust evidence; to substantiate PBF's effect on improving, for example institutional delivery to reduce maternal mortality in LMICs.