Performance-Based Financing, a Successful Approach to Improve the Involvement of Private Health Structures in Primary Health Care Delivery, Case of the Koulikoro Region in Mali

Introduction : Since 2020, Mali has been implementing a performance-based financing (PBF) program to reform its health financing approach as part of its march towards universal health coverage, one of the Sustainable Development Goals. A key feature of this program is the inclusion of all types of health care providers, including private health facilities (FOSA). Four years after the implementation of this inclusion, this study was initiated to assess its influence on the level of certain services offered in the Koulikoro region. Study Methodology : This was a retrospective descriptive study of the data entered into the RBF Program Information Management Portal. Results : From 2020 to 2023, the proportion of 133 private health facilities in the program intervention area that were able to sign a performance contract increased from 29 to 77 percent, or 5 to 12 percent of the total number of contractors. The proportion of private sector prime contractors increased from 0 to 11 percent, which likely led to an increase in the proportion of private FOSAs applying more than 70 percent of the minimum package of activities (MPA) from 0 to 31 percent. During the same period, the number of private FOSAs declared in the national statistical yearbooks increased from 129 to 409 in the Koulikoro region. By the end of 2023, private FOSA accounted for up to 42 percent of consultations conducted by doctors at the ART level, 16 percent of first prenatal consultations before 4 weeks of pregnancy, 19 percent of the fourth prenatal visit before delivery, and 18 percent of deliveries attended by skilled personnel. The proportion of births assisted by private FOSA increased from 0 to 18 percent in 4 years, the proportion of adolescents placed on intrauterine implants/devices by private FOSA increased from 2 to 19 percent, and HIV testing among pregnant women increased from 1 to 15 percent. Conclusion: The implementation of results-based financing activities in private health facilities has