Implications of Performance-based Financing Implementation for Maternal and Child Health Outcomes in Nigeria: A Scoping Review

Background: Performance-based financing (PBF) is seen as an open health system reformtailored to suit the needs of countries, even in a fragile context. It is thought to have the ability to address the strategic challenges of the sustainable development goals. This study explored the implementation of PBF in order to determine whether it improves maternal and child health outcomes in the Nigerian context. Methods: This was a scoping literature review of online multiple databases and programme implementation documents. Six databases and an online library were searched using 30 key words, alone and in combination using Boolean terms. Thirty articles and five implementation documents were screened. At the end, 25 published articles and five implementation documents were reviewed. An adapted World Bank PBF conceptual framework was used for the review. Results: We found mixed results across most of the service indicators consistent with findings in most lower, middle income countries. In both pilot states, the quality of health services, mainly technical, improved remarkably. There was improved utilisation of maternal and child health services, particularly institutional delivery, modern contraceptives and under-five vaccination. However, client dimension of quality was reportedly poor. The study found no impact of PBF on equity. Conclusion: Collaborative partnership to develop policy frameworks for demand-side incentives to ensure equitable access to health services and sustainability of the project is essential. We further recommend that more incentives be paid for client quality dimension.