Table 7 Typical PBF pilot testing package, World Bank/HRITF-funded schemes

World Bank- and HRITF-funded schemes are typically implemented in the following stages:

1. Setting an independent project management unit at the central level

2. Drafting a PBF manual in collaboration with the Ministry of Health (i.e., operating procedures for contract agreements, including specifying PBF indicators and how rewards are calculated and distributed)

3. Arranging two competitive calls for tenders: 1) between private companies willing to act as purchasing agency or “contract development and verification agency”; 2) between private companies willing to act as fiduciary agency

4. Introducing a strict separation of functions through contracting the selected purchasing agency or “contract development and verification agency”

5. Training the multiple actors (i.e., regulator; purchaser; payer; healthcare providers) involved in the pilot scheme

6. Setting a steering committee at the government level and (possibly) a PBF unit within the Ministry of Health

7. Launching the pilot scheme in selected health districts

8. Ensuring smooth operationalization of pilot scheme (i.e., completion of contract agreements, verification, counter-verification, regular meetings of the steering committee)

9. Evaluating the pilot scheme (e.g., through a formal impact evaluation).

Source: Data aggregated from 57 interview transcripts and 10 observation notes