Strengthening Equity in Access to Basic Health Care for Indigents via PBF: Selected Key Results in Koulikoro Region, Mali

Introduction: Performance-Based Financing (PBF) can improve access to health care for vulnerable populations, especially those living in insecure areas [8-25]. However, to achieve this goal, careful consideration must be given to the multidimensional challenges faced by these people. Studies highlight the complexity of improving access to health care for the indigent/vulnerable, as they face many barriers [18-24]. These barriers are often interrelated and require a holistic approach to overcome. Despite these challenges, PBF can be effective in reaching vulnerable populations when implemented by incorporating equity measures, empowering health facilities to make autonomous decisions. These different recommendations were taken into account in the PBF model implemented in Mali from 2020 to 2024. The purpose of this study was to assess whether this model improved the performance of the government's medical assistance scheme for indigents. Methods: This was a retrospective quantitative cross-sectional study of data collected from the reports of the social information subsystem from 2017 to 2020, the RBF portal, and the quarterly activity reports of the contracting and verification agency from 2021 to 2023 for all health facilities under PBF contracts in the ten districts of the Koulikoro region. Results: The results of our study show that, with PBF, in addition to the 10 district hospitals that provided facilities for the indigent, 290 CSComs, 112 for-profit private facilities, 343 village maternity hospitals, and 230 community health workers participated in the provision of services to this segment of the population. Thus, the average number of beneficiaries of support in each of the 10 districts increased from 248 people in 2020 to 1367 in 2021, then 3993 in 2022 and 6882 people in 2023. Compared to 2020, the rate of increase in the number of people cared for increased to 482% in 2021, 1600% in 2022 and 2745% in 2023. Conclusion: Integrating equity measures in PBF pro