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dc.rights.licenseCreative Commons Attribution License (CC BY 4.0)
dc.contributorYao, Nengliang (Aaron)
dc.contributor.authorBertone, Maria Paola
dc.contributor.authorFalisse, J-B
dc.contributor.authorRusso, Giuliano
dc.contributor.authorWitter, Sophie
dc.identifier.citationBertone, M.P., Falisse, J.-B., Russo, G. and Witter, S. (2018) ‘Context matters (But how and why?) A hypothesis-led literature review of performance based financing in fragile and conflict-affected health systems’, PLOS ONE. Edited by N. (Aaron) Yao, 13(4), p. e0195301. Available at:
dc.description** From PLOS via Jisc Publications Router. ** History: received 11-07-2017; collection 2018; accepted 20-03-2018; epub 03-04-2018. ** Licence for this article:
dc.description.abstractPerformance-based financing (PBF) schemes have been expanding rapidly across low and middle income countries in the past decade, with considerable external financing from multilateral, bilateral and global health initiatives. Many of these countries have been fragile and conflict-affected (FCAS), but while the influence of context is acknowledged to be important to the operation of PBF, there has been little examination of how it affects adoption and implementation of PBF. This article lays out initial hypotheses about how FCAS contexts may influence the adoption, adaption, implementation and health system effects of PBF. These are then interrogated through a review of available grey and published literature (140 documents in total, covering 23 PBF schemes). We find that PBF has been more common in FCAS contexts, which were also more commonly early adopters. Very little explanation of the rationale for its adoption, in particular in relation with the contextual features, is given in programme documents. However, there are a number of factors which could explain this, including the greater role of external actors and donors, a greater openness to institutional reform, and lower levels of trust within the public system and between government and donors, all of which favour more contractual approaches. These suggest that rather than emerging despite fragility, conditions of fragility may favour the rapid emergence of PBF. We also document few emerging adaptations of PBF to humanitarian settings and limited evidence of health system effects which may be contextually driven, but these require more in-depth analysis. Another area meriting more study is the political economy of PBF and its diffusion across contexts.
dc.relation.ispartofPLOS ONE
dc.rightsCopyright: © 2018 Bertone et al.
dc.subjectResearch Article
dc.subjectSocial Sciences
dc.subjectMedicine And Health Sciences
dc.subjectPeople And Places
dc.titleContext matters (but how and why?) A hypothesis-led literature review of performance based financing in fragile and conflict-affected health systems
dc.contributor.sponsor** Funder: Department for International Development; Grant num: ReBUILD; funder-id:
qmu.authorWitter, Sophie
qmu.authorBertone, Maria Paola
qmu.centreInstitute for Global Health and Development
dc.description.number4 [e0195301]

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Creative Commons Attribution License (CC BY 4.0)
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