School of Public Health, Université Libre de Bruxelles, Brussels, Belgium.
Bull World Health Organ. 2011 Sep 1;89(9):695-8. doi: 10.2471/BLT.11.087379.
Over the past 15 years, performance-based financing has been implemented in an increasing number of developing countries, particularly in Africa, as a means of improving health worker performance. Scaling up to national implementation in Burundi and Rwanda has encouraged proponents of performance-based financing to view it as more than a financing mechanism, but increasingly as a strategic tool to reform the health sector. We resist such a notion on the grounds that results-based and economically driven interventions do not, on their own, adequately respond to patient and community needs, upon which health system reform should be based. We also think the debate surrounding performance-based financing is biased by insufficient and unsubstantiated evidence that does not adequately take account of context nor disentangle the various elements of the performance-based financing package.
在过去的 15 年中，绩效融资在越来越多的发展中国家得到实施，特别是在非洲，作为提高卫生工作者绩效的一种手段。在布隆迪和卢旺达扩大到国家实施，促使绩效融资的支持者将其视为不仅仅是一种融资机制，而且越来越多地将其视为改革卫生部门的战略工具。我们反对这种观点，理由是基于结果和经济驱动的干预措施本身并不能充分满足患者和社区的需求，而卫生系统改革应该基于这些需求。我们还认为，围绕绩效融资的争论受到证据不足和未经证实的偏见的影响，这些证据没有充分考虑到背景，也没有理清绩效融资方案的各个要素。
