Primary Health Care (PHC) has inspired and galvanized action on health. PHC affirms that health is a state of complete physical, mental and social wellbeing and not merely the absence of disease and that health is a fundamental human right. In the past decade, global institutions have promoted and channeled external funds through performance based financing (PBF), as a strategy to improve service delivery and access. While there have been studies on whether these particular services targeted under PBF have improved, there has been little systematic evaluation of its system-wide effects, nor of its impacts on comprehensive PHC. In EQUINET, we thus saw it to be important to ask: How is the use of targets in PBF affecting health workers’ professional roles, work and interaction with communities and their ability to deliver comprehensive PHC? In 2018-2019 the PAR involved 21 online participants from seven sites in five ESA countries, including health workers from primary health cent res, community members in HCCs and country site facilitators from seven national health civil society organisations in the region, referred to in this brief collectively as the ‘online participants’. We also included offline local discussions with an average of 19 community members and 15 health workers per site. Four major areas of action and ten proposals were made within them for PBF to enable and not detract from PHC. This brief presents the general findings and proposals and in addition those specifically for district and national health authorities and funders.
Resource allocation and health financing
Title of publication Ensuring that target-driven funding supports and does not harm comprehensive primary health care in east and southern Africa: Brief for district and national level
Date of publication
Primary health care; performance based financing; participatory action research; east and southern Africa
East and southern Africa region
Equinet Publication Type